Eligibility Online Manual
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
POL M1201A: DETERMINING ELIGIBILITY FOR NEWBORN
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 moves out of state
Periodic review is not completed
Defining Group: 42 CFR 435.117
Social Security Act § 1902(e)(12)
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.
1. Send 15-Day closure notice when an adverse action has occurred.