In some situations, the CAO must extend MA coverage without a review of eligibility.
The following individuals and budget groups can get extended MA benefits:
A newborn whose mother recieved MA or CHIP at the time of birth
A pregnant woman following the termination of pregnancy
A Low-Income Family (MG27) recipient whose household income goes over 33% FPIG because of an increase in spousal support (alimony) or earned income
NOTE: This extension is known as Transitional Medical Assistance (TMA). (See Chapter 339, Transitional Medical Assistance.)
If the recipient is not eligible for extended medical coverage, then the CAO must review eligibility for other MA programs. If all conditions are met, the CAO must approve MA before stopping the current benefits.
The CAO approves MA for up to one year for a newborn child if all of the following conditions are met:
55 Pa. Code § 141.81(c)(3)(ii)(A)
The child is born to an individual with MA or CHIP at the time of birth.
NOTE: This may include an MA recipient with foster care or adoption assistance.
The CAO was notified by the parent, another responsible individual, the provider, a BABY alert, a Newborn Eligibility Form (MA 112), an application for MA benefits signed by the parent confirming the birth.
NOTE: These rules also apply to a child born to a non-citizen eligible for Emergency MA (EMA) only whose labor and delivery were covered by MA.
NOTE: When an invoice from an MA provider cannot be processed because the newborn has not been added to eCIS, the CAO must get no more than three case alerts (BABY) before the newborn is approved for MA. If a third alert is issued, eCIS will send a report to the Executive Deputy Secretary, the Deputy Secretary for Income Maintenance, and the Area Manager. The CAO will consider the first case alert it gets to be notice of the birth of the child.
A renewal is not required for a newborn until the newborn reaches the first birthday. A renewal will be completed before the end of the child’s one year of eligibility.
When the CAO is told of the birth they will do the following:
1. Add the newborn to the case using an Individual Add workflow.
2. Approve MA for the newborn’s date of birth if the mother had MA on that date. The date of birth is the eligibility date in eCIS.
NOTE: This applies to a child of a woman who is retroactively eligible, and to a child born to a non-citizen eligible for Emergency MA (EMA) only whose labor and delivery were covered by MA.
NOTE: A newborn does not need to have a Social Security number for MA benefits. If the newborn does not have a Social Security number at renewal, enumeration conditions must be met at that time.
Approve MA in the appropriate category. The eligibility date is the newborn’s date of birth.
Exception: If the child is born during the 45-day Presumptive Eligibility for Pregnant Women eligibility period, do not use the MA 112. The newborn is not automatically eligible for one year but is eligible if the mother is eligible for ongoing MA. (See Section 312.81 PE for Pregnant Women.)
Approve MG 18N for the newborn if the mother is not eligible for MA benefits because of income.
3. Set a renewal due date 12 months from the date of birth. A renewal is not needed until the newborn reaches the first birthday. It must be completed before the end of the child’s one year of eligibility.
4. Send the mother a notice to applicant to let her know that the newborn is eligible for MA.
The medical facility fills out the MA 112 when it knows the mother is an MA recipient. The medical facility must contact the CAO as soon as possible after the birth of the child. MA for the newborn should be approved at the first contact.
NOTE: If the hospital does not provide an MA 112 in a timely way, the CAO will approve MA back to the date of birth when it finds out about the child’s birth or when it gets a signed and dated application.
When the CAO gets the MA 112, it does the following within three working days:
1. Complete the MA 112 following the instructions in Appendix B.
NOTE: If the newborn was approved and added to the applicant or recipient group before the MA 112 came in, the CAO fills out the form and returns it to the provider.
NOTE: If the newborn has not been approved by the time the MA 112 comes in, follow instructions in 338.41.
2. Return the hospital copy within three working days.
NOTE: MA providers who are registered COMPASS Community Partners can use COMPASS Newborn Add to report a newborn’s birth through COMPASS. Newborn Add can be used by the provider in place of submitting a paper MA112.
A woman who has MA at the end of her pregnancy is eligible for continued MA through the last day of the month in which the postpartum period ends. MA is continued for the postpartum woman, regardless of changes that may affect MA eligibility.
Continued eligibility starts on the date the pregnancy ends and finishes on the last day of the 12th month when the postpartum period ends. Postpartum includes live birth, stillbirth, miscarriage, or abortion. Coverage is also extended if the child is placed for adoption or in foster care.
If an SSI budget is terminated/closing for a pregnant or postpartum individual, that individual is eligible for continued MA coverage until the end of the 12-month postpartum period.
If an individual open for MA reports a birth of a child, the CAO will add the child to the case and enter a pregnancy termination date on the Pregnancy screen of the individual who gave birth. If a pregnancy was not previously reported, the CAO must create a new Pregnancy screen. The pregnancy termination date must match the child’s date of birth.
It is important for the CAO to enter the correct pregnancy termination date on the Pregnancy screen to ensure the parent receives the full 12-month continuous postpartum coverage. The PA 1961 has been updated includes a question for the CAO to review the case for postpartum individuals to prevent incorrect closures.
NOTE: Because pregnant individuals are entitled to the 12-month postpartum coverage regardless of the reason pregnancy ends, the CAO will make sure a Pregnancy screen is entered in the Electronic Client Information System eCIS with the correct pregnancy termination date even if the pregnancy did not result in a live birth
Pregnant and postpartum individuals can only be closed during their periods of continuous eligibility for the following reasons:
Individuals in the postpartum period whose MA closed for voluntary withdrawal or move out-of-state are entitled to the remainder of the postpartum period if they reapply prior to the end of the 12-month postpartum period.
The CAO will review eligibility for MA, including Family Planning Services when postpartum period is ending.
MA coverage must continue for pregnant and postpartum women and eligible children under age one unless closing for one of the reasons outlined in 338.42.
1. Enter the pregnancy (if not already entered) and the pregnancy end date in eCIS, allowing the system to calculate the postpartum end date.
2. Run eligibility to place the individual in the appropriate category for the period of postpartum.
NOTE: MG00P should not be opening after the first 60 days of the postpartum period unless there is a new pregnancy reported.
3. The system will set the renewal date for the individual’s postpartum MA budget to the end of the 12-month postpartum period. Exceptions to this are MG71 budgets, budgets with more than one individual such as TC/TU, and MA budgets where the postpartum end date is before the individual’s current renewal date.
4. At the end of the postpartum period, run a renewal or run eligibility (depending on when the renewal is due for the case) to determine ongoing eligibility. If ineligible for ongoing MA, send the woman a 15-day advance notice before terminating MA or reducing MA benefits.
See Chapter 339, Transitional Medical Assitance (TMA).
See Chapter 387, Supplemental Security Income (SSI).
Updated August 26, 2025, Replacing September 19, 2023