Family Healthcare (FAMIS) Manual – Table of Contents

0930.010.00 ELIGIBILITY (Newborns)

IM-#60 June 12, 2006

Children born to a woman eligible for and receiving MC+ or Medicaid on the date of the infant’s birth, continue to be eligible for MC+ Healthcare throughout the first year of life as long as the infant remains in the mother’s home and the mother remains eligible for MC+ healthcare (or would remain eligible if she were still pregnant).

This newborn policy applies to all federally funded MC+/Medicaid recipients identified below.

  1. Medical Assistance for Families Program
  2. MC+ for Pregnant Women Program
  3. Refugee Assistance Program
  4. Supplemental Payments
  5. Medical Assistance Program
  6. Medical Assistance For Children In Care Program
  7. Supplemental Nursing Care Program
  8. Supplemental Aid To The Blind Program
  9. MC+ for Children, Custodial Parents, non-Custodial Parents
  10. Transitional Medical Assistance

Exceptions are:

  1. Those persons whose Medicaid is state funded. This means newborn children of Blind Pension recipients are not eligible under this policy.
  2. Children whose mother has a pending application for assistance, as the mother would not have been receiving at the time of the child’s birth. For example, a MC+ For Pregnant Women applicant who has the baby prior to the case being approved; the newborn policy does not apply as the mother was not a recipient at the time of the child’s birth.
  3. Women covered by the Extended Women’s Health Services Program.
  4. Adoptive parents: The newborn policy only applies to birth parents. For mothers who intend to relinquish their newborns, the policy will apply until the time of relinquishment as long as the mother continues to be Medicaid eligible or would if still pregnant and the child continues to live with the mother. This includes the time period in which both the mother and child are in the hospital.
  5. TEMP (Temporary Medicaid During Pregnancy) claimants are not regular Medicaid recipients. Thus, children born to TEMP only claimants are not eligible for Medicaid coverage under the newborn policy. If, at the time of the birth, the TEMP claimant has already been approved for regular Medicaid by FSD, the child qualifies for Medicaid as a newborn.
  6. Medical Assistance spend down: If a pregnant woman applies on April 10 for Medical Assistance, the baby was born May 3 and the mother’s spend down was not met until May 9, the newborn is not eligible as the mother was not a Medicaid recipient at the time of birth. If the mother’s spend down in this situation was met on May 3, the newborn would still not be eligible under the newborn policy as the mother was not an active Medicaid recipient when the child was born.