Family Healthcare (FAMIS) Manual – Table of Contents

0930.010.20 Approve The Child With Appropriate Level Of Care

IM-#60 June 12, 2006,  IM-#1 February 13, 2004

Newborns do not have to be added as a level of care “G” on a Newborn case, but must be added at a level of care that provides full Medicaid/MC+ benefits. It would be appropriate to approve the newborn under a MAF case with a “T” level of care or as a “Q” level of care under MC+ since coverage is equivalent. The newborn should be coded as such and eligibility moved to a NEWBORN case if under age 1 when future eligibility determinations result in coverage that is not equivalent to the “G” level of care.

Infants eligible for newborn coverage should not be added to a MC+ case with a CHIP level of care (1, 2, or 3) as there are restrictions with CHIP coverage. If the newborn would be CHIP based on current circumstances, open a Newborn case. The newborn should be added to the MC+ case as an included (Z) individual if adding the child would result in a beneficial change in the other children’s eligibility (examples: lowers premium amount for family, changes other children from LOC 1 to LOC Q).

Infants born to MA recipients should have their eligibility established by registering and processing a NEWBORN application. This also applies to MA spend down recipients. The Newborn is eligible for MC+ healthcare for one year regardless of the mother’s continued spend down eligibility.

When the mother is no longer receiving MC+ healthcare or Medicaid, notification of the birth is received, and the child is not eligible for another non-CHIP type of assistance, register a “NEWBORN” application in the mother’s name and DCN. Use the income figures from the mother’s last MPW budget and approve the case. If the mother was not receiving MPW, but was on another form of federally-funded Medicaid, enter zero income figures on the Newborn case and approve.

If notification of the birth of the newborn child is several months after the birth, a Newborn application can be IAPP’d in with the date of notification and the newborn approved beginning with the date of birth, as long as:

  • the child is not one year of age,
  • the mother was receiving MC+ or Medicaid at the time of the birth,
  • the mother has remained continuously eligible for MC+ healthcare (or would have if she were still pregnant), and
  • the child has lived with the mother from the time of birth.