|NEWBORN/MC+ FOR PREGNANT WOMEN POLICY CLARIFICATIONS, FAMILY HEALTHCARE MANUAL REVISION #1, SECTION 0925.020.10.05 , SECTION 0930.010.05 -0930.10.20|
This memorandum is to address a number
of issues brought to our attention where staff appear confused about appropriate
policy and procedures for Newborns and MC+ for Pregnant Women.
Newborn children eligible for automatic MC+ eligibility (G level of care) are children born to a woman eligible for and receiving MC+ or Medicaid on the date of the infant’s birth. The newborn policy applies to all federally funded MC+/Medicaid recipients. Refer to 0930.010.00 of the Family Healthcare Manual. Problem areas are addressed below:
We have discovered many infants meeting the definition of newborn are not being approved for Medicaid/MC+ within 10 days of being notified as addressed in Section 0930.010.05 of the Family Healthcare Manual. Notification of birth can be accepted from the parent(s), parent’s representative, the hospital or their representative, or the managed care healthcare plan. A signed application is not necessary and parent is not required to complete any paperwork. Do not wait for a copy of the hospital certificate to add the child. Acceptable verification of the birth is addressed in 0930.010.05 of the Family Healthcare Manual.
Department of Health and Senior Services assigns DCN to infants when registering the birth. Staff cannot assume there is not a DCN assigned to the child simply because it is a newborn the mother hasn’t received. Appropriate clearing must be done to insure duplicate DCNS are not assigned to newborns.
An infant meeting the newborn criteria is eligible back to the date of birth regardless of when the child is added. The IMU5 system will accept a G level of care back to the date of birth as long as the child isn’t turning age one in the same month of approval.
Newborns do not have to be added as a level
of care “G”, but must be added as a level of care that provides full
benefits. A newborn indicator must be entered in field 13(O2) of
It is appropriate to approve the newborn under a MAF with a “T” level of care or as a “Q” level of care under MC+ since coverage is the same as “G” level of care. The newborn should be coded as such in field 13(O2) of IMU5 and eligibility moved to a NEWBORN case if under age 1 when a future eligibility determination results in coverage that is not equivalent to G level of care.
Infants born to MA recipients should have
their eligibility established by registering and processing a NEWBORN
On a MC+ for Pregnant Women case the postpartum ending date determined by expected delivery date is entered into field 32 of the IMU5 at time of approval. Postpartum eligibility terminates on the last day of the month containing the 60th day after the termination of the pregnancy for women who apply while pregnant.
The postpartum eligibility end date may
be incorrect once we determine when the child was born. If
we become aware of the birth prior to postpartum ending, make corrections
to the ending date in field 32 based on the child’s month of birth.
Example: Approved same as above. However, she delivered the baby Nov. 30, 2003. The ending date for postpartum should be changed to January 31, 2004.
Newborn eligibility continues through the infant’s first birthday unless the child no longer resides with the mother or is no longer a Missouri resident.