Eligibility Online Manual

M1201A Newborn

Purpose: This section will assist in determining eligibility for a newborn of a Medicaid eligible mother.

Current Policy Effective Date: July 1, 2018

Date Last Reviewed: July 1, 2018

Previous Policy: January 1, 2014


1. Newborns With Medicaid Eligible Mothers Receive Automatic Eligibility

An application is not required.

This includes newborns of mothers eligible under any Medicaid program, including Emergency Services, Family and Children's.

2. Benefits Begin In The Month Of Birth And Continue Through The End Of The Month Of The Child’s First Birthday.

3. Clients Must Be Reviewed

Clients must be periodically reviewed in the month of their first birthday to determine continued eligibility under another Medicaid program. Refer to Section M1403 for information on reviewing eligibility.

Clients tax filer status is not required until clients periodic review in the month of their first birthday.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

4. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

    • Child dies

    • Child moves out of state

    • Periodic review is not completed


Defining Group: 42 CFR 435.117

Social Security Act § 1902(e)(12)

Clarifying Information:

Applicants May Be Eligible Under Another Coverage Group.

1. If the Mother is not Medicaid eligible, determine eligibility for the newborn under another coverage group.

Newborns Are Not Required To Meet Basic Eligibility Factors.

Worker Responsibilities:

Closing Cases

1. Send 15-Day closure notice when an adverse action has occurred.