Family and Children's Medicaid MA-3230 ELIGIBILITY OF INDIVIDUALS UNDER Age 21
IV. POLICY RULES - AUTOMATIC NEWBORN, M-AF OR M-IC
A. The Newborn
1. Is not required to meet the regulations for the M-AF or M-IC aid program/category as described in I. or II., nor is he required to provide U.S. citizenship and identity documentation.
2. Is deemed to have filed an application for assistance and been found eligible for Medicaid if he:
a. Is born to a woman who is eligible for Medicaid on the date he is born or who is later approved for Medicaid with an authorization effective no later than the child’s date of birth, and
b. Lives in North Carolina, or is temporarily absent.
REISSUED 07/01/10 - CHANGE NOTICE 08-10
3. The child continues to be authorized as a newborn through the month he turns one year of age as long as he continues to live in North Carolina, or is temporarily absent.
B. Determining Whether Automatic Newborn Coverage Applies
d. The mother specifically requests in writing that the newborn not be covered. File the written request in the case record. The record must include documentation that the mother understood that the newborn may be eligible for Medicaid and the mother chose for him not to be covered.
REVISED 07/01/10 - CHANGE NOTICE 08-10
1. For Automatic Newborn Coverage, Document that the Child:
a. Was born to a mother who is an authorized Medicaid recipient on the date of birth or whose application is later approved for coverage on that date, and
b. Lives in North Carolina, or is temporarily absent, and
c. Is less than 1 year of age. (He may remain eligible under automatic newborn coverage through the month in which he turns one year of age.)
2. Documentation of automatic newborn eligibility verifies identity and that the child is a U.S. citizen. No further verification of citizenship and identity is needed at the end of the automatic newborn coverage. See MA-3332, US Citizenship Requirements, for documentation procedures
3. Consider income/resources of the newborn at the end of the automatic newborn coverage when continued eligibility is evaluated.
4. When Notification of Birth is Given:
a. Obtain the newborn’s name, sex, and date of birth in order to authorize,
b. Use the race of the mother for the race of the newborn unless it is reported to be different from hers.
5. Do Not Authorize A Newborn Until He Has A Name, Unless He Dies At Birth.
a. Request the newborn’s name as soon as possible. Medicaid cannot be authorized until a name is provided, except in case of death.
b. If no name is indicated when notification of the birth is received, contact the parent and the person/agency that provided the notification and document the contact in the case record.
c. If the newborn died shortly after birth, contact the hospital and ask for the name the hospital will use to submit claims. Key in that name in EIS. Refer to the EIS User’s Manual.
d. Authorize the newborn within 5 work days of receipt of the name and document the case record with the date the name is received.
REISSUED 07/01/10 - CHANGE NOTICE NO. 08-10
6. Sources Of Notification Of The Newborn’s Birth Include, But Are Not Limited To:
a. A verbal or written statement from any person who has knowledge of the newborn’s birth, including parent(s), doctors, nurses, Maternity Care Coordinators, social workers, relatives, etc., or
b. A copy of the DHS-1201, Certification of Live Birth, or
c. The DMA-5020, Notification of Case Status/Referral for Inpatient Hospital Services. If the DMA-5020 is used by the hospital, the reverse side must be completed within the 15-day time standard stated on the form. Return the form to the referral source. Include the newborn’s Medicaid identification number on the form.
D. Instructions For Authorization
1. Continue automatic coverage for a child born to a mother who was covered by Medicaid for the delivery through the month the newborn turns age one when the newborn lives in North Carolina, or is temporarily absent.
2. Mother Receives Work First
If the mother receives Work First, follow procedures in Work First-202 for including an automatic newborn who is a family unit member. If the child is later found ineligible for Work First, authorize the newborn under M-AF or M-IC to ensure that he receives automatic coverage through the month of his first birthday.
3. When adding the newborn to an existing Medicaid case, follow EIS procedures for add individual applications in EIS-2012. The date of application is the date you learn of the child's birth.
4. If a new case must be opened for the child, complete the following forms:
a. Enter a DSS-8124 screen in EIS as administrative. The date of application is the date of birth. A signed application is not required.
b. Complete the DMA-5063BB, Verification/Eligibility Determination Document, Supplement BB, Change in Situation form, documenting the newborn’s eligibility.
c. Enter a DSS-8125 screen in EIS. Refer to the EIS User’s Manual for instructions, if needed.
REVISED 07/01/10 - CHANGE NOTICE NO. 08-10
d. Certification/authorization begins with the newborn’s month of birth and continues through the month the child turns age 1.
E. Automatic Newborn Protection Ends
1. All Cases
a. When automatic newborn coverage ends, complete a redetermination to evaluate the child for ongoing eligibility in all other aid programs/categories. The redetermination of Medicaid eligibility should be completed no later than the end of the month the child turns age one. Do not require further citizenship and identity verification of children born in U.S. hospitals whose delivery was covered by Medicaid. See MA-3332, US Citizenship Requirements, for documentation procedures.
b. If the redetermination is not completed by the end of the month of the first birthday, extend the certification period for an additional month until the redetermination is completed. Refer to MA-3420, Re-Enrollment.
2. Do not terminate Medicaid until it is determined that he is ineligible under all other aid program/categories.