PM 18-03-03

  1. Adding Newborns
  2. Spenddown Cases
  3. Adding Newborn to Canceled Medical Case
  4. IES Phase 2 Action When Deemed Newborn Reaches Age 1

Adding Newborns

  1. If the mother is part of the benefit unit at the time of birth, add the newborn right away for medical when notified of the birth. This can be from any source including but not limited to:
    • the mother/father; or
    • the medical provider (including AKAAs, MCOs and hospital vendors); or
    • receipt of Record of Birth (Form 2636); or
    • receipt of Medical Coverage Request for Newborns (Form 2761).
  2. When the newborn is added to the case, a medical card is automatically generated for the newborn. 
  3. If the client provides the needed proofs before the child is one year old, delete code 3 from Item 78 and enter a dash.
  4. If the client hasn't completed Form 243C and provided the needed proofs when the child is one year old and it is more than 12 months from the Last Medicaid Determination Date (LMDD), send Form 157 and delete the child from the Assist or Moms & Babies case.
  5. If the newborn is the only child in the case and it is more than 12 months from the LMDD, cancel the Assist or Moms & Babies case. Enter the following reason on Form 157:
    Your infant's 12 months of medical benefits has ended. You have not applied for ongoing medical coverage. 

Spenddown Cases

For inactive spenddown cases, if the spenddown case is in canceled not met status, see WAG 18-03-10 and WAG 18-05-07.

Adding Newborn to Canceled Medical Case

  1. (FCRC) When adding a newborn to a canceled Family Health Plans case, determine if the case is eligible for the addition.
    • Case must meet all nonfinancial and financial eligibility factors for the period of medical coverage being requested.
    • Case must not have been canceled for more than 24 months.
  2. (FCRC) When the newborn is added to a canceled spenddown case, refigure the spenddown amount.
    1. Document the new spenddown amount in the case record and enter it in ASDS.
    2. Send Notice of Changes During the Medical Assistance Enrollment Period or Eligibility Period (Form 2434A), (with Form 458SPA/SPB attached, if needed), to notify the client of the new spenddown amount.

      NOTE: Case does not have to be in met status for the period requested.

      Example: A spenddown case was open 08/02 - 07/03. A child born 08/31/02 was not added to case. The newborn is determined Moms and Babies eligible. Add the newborn to the canceled case for 08/31/02 - 07/31/03. 

  3. (FCRC) If case is eligible for the addition, see WAG 18-03-03 to add a newborn to the case.
  4. (System) Sends a Medical card if the newborn is eligible for Assist, Moms and Babies, or is in Family Health Spenddown met status for the period requested.
  5. (FCRC) Send Request for Correction/Addition of MMIS Medical Eligibility File (Form 2958) to Exception Processing Unit (EPU) to cover any other month(s) of medical eligibility in the backdated period.
    1. File copy of Form 2958 in case record.
  6. (EPU) Sends Medical Eligibility Change/Correction (Form 1313D) to the FCRC.
  7. (FCRC) Send client Notice of Decision to Add a Person to a Medical Assistance Case (Form 1934A) within 45 days from the date of the written application. The date of the written application is the date the application is received in the correct Family Community Resource Center.

IES Phase 2 Action When Deemed Newborn Reaches Age 1

revised textNewborns whose mother was covered for HFS medical benefits for the newborn's birth are deemed eligible and are continuously eligible for medical benefits until they are a year old regardless of changes in income.

Rather than aligning a deemed newborn's certification period with the other medical EDGs on a case, the newborn's cert period will be set to end after they turn 1 year old. Prior to their 1st birthday, IES initiates a REDE to determine continued eligibility under another medical program. The newborn must now meet income and SSN (or application for SSN) criteria and a written request to add the child is required if not yet on file.

  • Note: This special certification period applies to deemed newborns only. When adding other children to the case, including newborns who are not deemed eligible, their certification period will be aligned with other medical EDGs that are active on the case.  

When adding a deemed newborn in IES it is important to indicate on the newborn screen whether a written request was already received. This will prevent IES from requesting another 243C when the child turns a year old.