Appendix B: Newborn Eligibility Process

The [Newborn Eligibility Form (MA 112)] must be filled out when a current MA recipient gives birth. The form includes instructions for filling it out.

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.

Hospital

• Fill in the unshaded areas of the form as follows:

• Fill in items 1, 2, 4, 5, 8, and 11–5 with information from the ACCESS card of the parent who gave birth.

• Fill in items 18–22 to identify the newborn. The name may be filled in as "baby girl" or "baby boy."

• Fill in item 34 if information on third-party resources is available.

• Fill in items 37–43.

• Get the recipient’s signature, and date the form (items 35 and 36).

• Send the form to the CAO within ten days of the birth. Keep the provider copy.

CAO

• When the MA 112 comes in, stamp the date on it, and enter the information from it into Application Processing.

• Review and process the form within ten working days after it comes in.

• If the parent was not covered by MA on the date they gave birth:

1. Write “No medical eligibility on file” in the comments section of item 33, and sign and date it.
2. Return a copy to the hospital.

• If the parent was covered by MA on the date she gave birth:

1.  Fill in the shaded areas as follows:

1. • Fill in items 3, 6, 7, 9, and 10 with the right CIS codes and dates.

NOTE:  MA is being authorized for the newborn, the renewal date is 12 months from the open date.

1. • Fill in items 16, 17, and 18. if the newborn is not named - Use “NEWBORN” for data entry into CIS. In the case of unnamed twins, triplets, etc., use NEWBORN A, NEWBORN B, etc.

   • Fill in items 23, 24, and 26–32. Use the record number of the parent who gave birth. These items and item 19 are used by the hospital to bill MA.

   • Complete or correct the information on third-party resources in item 34.

   • Write “Action completed” in the comments section of item 33, and sign and date it.

2.  Update eCIS with the information from the MA 112.

3.  Open the MA budget for the newborn, effective on the date of birth.

Reminder: A child born to an MA or CHIP recipient is automatically eligible for MA effective the date of birth. A separate application on eligibility determination is not needed for the child.

4. Send a notice of eligibility. 

5. Return the hospital copy and file the CAO copy in the case record.

• If the newborn has already been added to the applicant/recipient group when the MA 112 comes in:

1. Fill in items 16, 17, 23, 24, and 26–32 with the case and budget information from CIS.
2. Write “Action completed” in the comments section of item 33, and sign and date it.
3. Return a copy to the hospital.

NOTE:  Data entry from the MA 112 is not needed.

Updated August 26, 2025, Replacing February 14, 2012