Family MO HealthNet (MAGI)

1855.030.05 Coverage for the Child After Birth

IM-#53, March 25, 2019IM-#142, November 22, 2017IM-#110, December 31, 2015

Senate Bill 716 (2014) ensures that children born to mothers approved for SMHB receive no-cost health coverage with no waiting period for their first year of life.

NOTE: Families may receive an invoice for $0 premium, but should disregard it.

Children of SMHB recipients who were denied MPW due to excess income only (income was above 196% of FPL, and mother is citizen or eligible alien) will receive Show-Me Healthy Babies Newborn (SMHB-NB) coverage (ME code 97).

Children of SMHB recipients who were denied MPW due to citizenship will receive the appropriate level of care for their reported household income based on the income at the time of the SMHB approval. (ME code 62, 74, or 75)  A Federal Grant Indicator (FGI) of 8 will show as a “C” on MXIX, and  show $0 premium, if appropriate.

EXAMPLE: Jane applied for coverage for her pregnancy on January 10, 20xx. Jane is not a US citizen or eligible alien. She was denied for MPW and approved for SMHB. Jane’s child was born February 19, 20xx. Current records show that household income is 190% of FPL. The Eligibility Specialist determines the child would receive coverage for Child Under 1 (ME 62) The FGI of 8 (shown as a C in the TOC field on MXIX) indicates the child is SMHB until age one. Before the child’s first birthday the household will be re-evaluated and the child moved to the appropriate level of care.

An ex parte review must be completed before the child turns age one (1).