Filing unit policy does not apply to a Family Health Plans case.
If the mother receives medical, the only information needed to add a newborn is the newborn's last name, date of birth, and sex. A newborn is eligible for medical up to age one without requiring a written request or verifications if the mother was eligible for and received medical when the child was born.
If the mother is not in the case, a written request and verifications are required.
When there is a written request, send a notice of approval or denial to the client no later than 45 calendar days from the date of the request. Under IES Phase 2, the Notice of Decision (Form 360C) is automatically generated when newborns are added to a case, and when a request to add a newborn is denied.
- NOTE: If the mother was receiving medical at the time of the newborn's birth, never put the newborn in spenddown status.
- Mother No Longer Receives Medical
The child may qualify for medical benefits in a Newborn EDG even if the mother no longer receives medical, but was eligible for and received medical at the time of the child's birth.
- Moms & Babies
See PM 06-09-00 to start medical.
- All Kids Share and All Kids Premium
See PM 06-08-00 to start medical.
Delete the child at age one if needed factors are not proven and the child is no longer eligible due to continuous eligibility. Both a written request and verifications are needed to provide Assist after 12 months.
IES Phase 2 Action When Child Reaches Age 1
Starting with IES Phase 2, a batch action trigger will rerun eligibility prior to the child turning a year old (see PM 19-08-00). As a result, IES will:
- determine continued eligibility for All Kids if a written request and verifications have been received, or
- generate a VCL (Form 267-Verification Checklist), and Form 243C (Request for Medical Benefits for Another Family Member) if needed, and create a VCL due date.