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.
If the mother is not in the case, a written request and verifications are required.
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.
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. If no written request was required, do not send a notice.
- Assist Cases
Add the newborn (back to the date of birth) and mail the MediPlan Card no later than 45 calendar days from the date of receipt of the written request.
- Family Health Spenddown Cases
Add the newborn and review the spenddown status. If appropriate, change the case from Family Health Spenddown to Assist. A written request must be filed at the end of the 12-month eligibility period.
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
If a mother no longer receives medical, but was eligible for and received medical at the time of the child's birth, add the child to the canceled case.
- Moms and Babies
See PM 06-09-00 to start medical.
- All Kids Share, All Kids Premium, and All Kids Rebate
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.