PM 18-03-03.

  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:
    • the mother/father; or
    • the medical provider (including KCAAs and MCOs); or
    • receipt of Record of Birth (Form 2636); or
    • receipt of Medical Coverage Request for Newborns (Form 2761).

      NOTE: Review Form 514 to ensure that the Newborn Unit has not already added the infant. See WAG 25-07-09-a to complete Form 552. 

  2. Issue a Temporary MediPlan Card for the newborn from date of birth through the expected date of the centrally issued MediPlan Card.
  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. text deleted
  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 and 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 and 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

  1. If the case is changed from Spenddown to Assist, the first system generated MediPlan card shows coverage starting on the date entered in Item 77 and ending on last day of current processing month (see WAG 18-05-04).
  2. 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 MediPlan 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.