Illinois Department of Healthcare and Family ServicesIllinois Department of Human Services

12/27/17

Summary:

  • A baby is automatically eligible for Moms & Babies as a deemed newborn when the mother was eligible for medical coverage at the time of the baby's birth.
  • Deemed newborns are automatically eligible for medical benefits regardless of whether or not the mother's coverage was approved before or after the baby's birth or whether or not the Department was aware that the mother was pregnant.
  • Removes outdated legacy system instructions from the manual and adds references to the IES Pregnancy and Newborn screens.
  • Newborns can be automatically added to a case via the Provider Portal in ABE.

  1. Deemed Newborns
    1. Mother Was In Family Health Spenddown
    2. Pregnant Women Under Age 19
  2. Pregnancy Reported on Active Case in IES
  3. Adding a Deemed Newborn in IES
  4. Provider Adds Newborn Via ABE
  5. Manual Revisions
  6. Forms referenced:

Deemed Newborns

A baby is automatically eligible for Moms & Babies as a deemed newborn when the mother was eligible for medical coverage at the time of the baby's birth under any of the following medical programs:

  • Moms & Babies
  • FamilyCare
  • All Kids Assist
  • AABD
  • ACA Adult
  • Former Foster Care

The mother can be approved for medical coverage before the baby is born or could be approved retroactively in a backdate request for medical. The newborn is automatically eligible regardless of whether or not the mother's coverage was approved before or after the baby's birth or whether or not the Department was aware that the mother was pregnant.

When the newborn is determined to be automatically eligible due to mother's eligibility for medical, an SSN or signed request for the baby is not required until age 1. Add the baby as soon as you learn of the baby's birth.

Mother Was In Family Health Spenddown

A baby born to a pregnant woman who is receiving Family Health Spenddown (met or unmet) at the time of the baby's birth is not automatically eligible. In this situation, determine eligibility for All Kids Share or Premium for the baby. Obtain a signed request for the baby (on the application or a Form 243A-C Request to Add an Additional Household Member) and an SSN or proof of application for an SSN.

Pregnant Women Under Age 19

An application for a pregnant teen under age 19 will progress to Moms & Babies, instead of All Kids Share or Premium (Level 1 or 2), if countable income is over the All Kids Assist level and at or below the Moms & Babies level of 213% of the FPL.

A teen in an active All Kids Share or Premium EDG will progress to Moms & Babies when the worker runs eligibility after a pregnancy is documented for the teen if countable income is at or below 213% of the FPL.

Note: Pregnant women and teens should progress to Moms & Babies only after having been determined ineligible for FamilyCare and All Kids Assist. Currently however, pregnant women and teens are being placed directly into a Moms & Babies (pregnant woman) EDG. IES will be updated. No case action is required to try to change the program prior to the IES update.

Pregnancy Reported on Active Case in IES

When a woman in an active medical case reports a pregnancy, enter the reported due date and number of births expected on the Pregnancy-Details screen in IES, and certify the change. Enter the information that the client provides; proof of pregnancy and proof of the number of expected births is not required. Enter the end date in the Pregnancy-Details screen when pregnancy ends due to a birth, miscarriage or abortion.

These actions ensure that the woman receives continuous eligibility for medical benefits through her 60 day post partum period. IES will rerun eligibility for the month following the end of the 60 day post partum period if the pregnancy ends prior to the end of the certification period. See PM 19-02-07 for information about certification periods for pregnant women and newborns. See WAG 19-08-00 for information about batch actions in IES.

Adding a Deemed Newborn in IES

IES determines that a child is a deemed newborn when the worker enters a 'Yes' response to this question on the Newborn-Details screen:

  • "Was the mother receiving Medicaid at the time of the birth? Y/N". 

Example 1: Child is born 07/03/18. Mom applies for herself and her newborn child on 08/02/18 and she asks for backdate. Income is at or below the Moms & Babies income limit in July. Both Mom and child are eligible for Moms & Babies. Answer the question above 'Yes'.

Example 2: Child is born 07/03/18. Mom applies for herself and her newborn child on 08/02/18 and she asks for backdate. Income is above the Moms & Babies income limit in July. Mom and child are NOT eligible for Moms & Babies. The child may be eligible for All Kids Premium but would be required to comply with the SSN policy. The Mom may be considered for Family Health Spenddown. Answer the question above 'No'.

Example 3: Child is born 07/03/18. Mom is receiving FamilyCare (there is no EDD on the case for her) in the month of July. The baby is automatically eligible for Moms & Babies even though the Department was not aware of the pregnancy. Add the baby as soon as you learn of the baby's birth; neither an SSN nor signed request is required to add the baby. Answer the question above 'Yes'.

Example 4: Child is born 07/03/18. Mom applies for the child but not for herself and she did not receive medical in July. The child is NOT eligible for Moms & Babies. The child may be eligible for All Kids Assist, Share, Premium (1 or 2) - but must comply with SSN requirements. Answer the question above 'No'.

Example 5: Child is born 07/03/18. Mom is under age 19 and is receiving Premium Level 1 in the month of July. Countable income is under 213% of the FPL. On 08/02/18 the head of household reports the birth and requests medical benefits for the newborn. The worker enters the new information into IES and reruns eligibility. The teen mom is eligible for Moms & Babies for the birth month, and through the post partum period. The baby is automatically eligible for Moms & Babies even though the Department was not aware of the pregnancy prior to the birth. Neither an SSN nor signed request is required to add the baby. Answer the question above 'Yes'.

Example 6: Child is born 07/03/18. Mom had an active ACA Adult case with a certification period that ended on 07/31/18. She had not reported her pregnancy and did not cooperate with the REDE. The case was canceled effective 08/01/18. On 08/02/18 the hospital reports the child's birth. The baby is automatically eligible for Moms & Babies even though the Department was not aware of the pregnancy prior to the birth. Neither an SSN nor signed request is required to add the baby. The worker reinstates the case for the deemed newborn and answers the question above 'Yes'. Mom has 90 days to cooperate with the REDE in order for her own coverage to be reinstated effective the month of cancellation.

Example 7: Child is born 07/03/18. Mom had an active Moms & Babies case in July. She is incarcerated on 07/30/18 and the baby goes to live with her sister. Set up a case for the baby in the name of Mom's sister. The baby is automatically eligible for Moms & Babies. Neither an SSN nor signed request is required for the deemed newborn until the child turns 1 year old. Answer the question above 'Yes'.

Provider Adds Newborn Via ABE

Designated providers who have access to ABE may submit a Record of Birth via the Provider Portal. IES then attempts to add the newborn automatically to the correct active IES case. Newborns are automatically added to IES when:

  • The birth is a live birth as noted on the Record of Birth page (not an adoption or deceased newborn);
  • The baby is identified by name and not simply, "Baby";
  • The identified newborn is not already active on a Medicaid case;
  • A matching individual is found in IES using the combination of the mother's SSN, First/Last Name, and DOB; and
  • A match is found in IES for the mother and that individual is currently receiving Medicaid.

When IES successfully adds a newborn to a case, a "Ready to Certify" task is created in the Newborn Add Queue in the Newborn Unit.

When IES cannot automatically add the newborn, a "Newborn Exception" task is created for the Newborn Unit worker to review the information and manually add the newborn to the case if appropriate. 

For more information see the Process Newborn Adds Submitted Via ABE job aid and the Newborn Unit WRAP.

Manual Revisions

WAG 06-09-03-a (deleted)

WAG 06-09-05

WAG 06-09-05-a

WAG 06-09-05-b (deleted)

WAG 06-09-06-a

WAG 06-09-06-b (deleted)

WAG 06-09-06-c (deleted)

WAG 06-09-06-d (deleted)

WAG 06-09-06-e (deleted)

WAG 18-03-03

[signed copy on file]

James T. Dimas

Secretary, Illinois Department of Human Services 

Felicia F. Norwood

Director, Illinois Department of Healthcare and Family Services

Forms referenced:

Form 243A-C