PM 18-03-03: Adding Newborn to Family Health Plans

WAG 18-03-03

Filing unit policy does not apply to a Family Health Plans case.

If the mother receives medical, the newborn's eligibility is 'deemed'. 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 was not covered for medical when the child was born, 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.

  • Mother Received Medical When Baby was Born

    Add the newborn back to the date of birth. 

    • 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.

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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. 

When Deemed Newborn Reaches Age 1

In IES Phase 2, deemed newborns receive a certification period that aligns with their 1st birth date. For example, if the newborn is born on July 4th, they will be certified until July of the following year, for a total of 13 months. 

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.