SUBJECT:
NEWBORN (G LEVEL OF CARE) APPLICATIONS AND APPROVALS
FAMILY HEALTHCARE MANUAL REVISION #12: SECTIONS 0930.010.00, 0930.010.20, 0930.010.25, 0930.015.00
DISCUSSION:
Effective immediately, approve all Newborn applications on a separate Newborn only case. Newborns can no longer be added to active Medicaid/MC+ cases as a “G” level of care. To prepare for the conversion of the Family Medical Programs into FAMIS, children receiving assistance at “G” level of care will be on their own individual case. Staff who attempt to add a Newborn as a “G” level of care to an active Medicaid case will receive the error, “Message: 171: Newborn not allowed on this type of assistance.”
Do not remove “G” children that are active on MC+ for Pregnant Women (MPW) and Extended Women's Health Services (EWHS) cases. Transfer “G” children that are active on any other type of Medicaid case, such as Medicaid for Families (MAF), MC+ for Children or on a parent's Medical Assistance case, to the child's own Newborn case whenever the active case is reviewed in the normal course of business. “G” babies may still be added to MAF or MC+ for Children cases with a “Z” Level of Care (Included) if it benefits the assistance group. Leave children on MAF/MC+ with a “Q” or “T” level of care and a Newborn Indicator (“Y”).
NOTE: Newborn cases are IAPP'd with the mother's DCN and the Newborn is added to the application. Legacy automatically puts the mother in “Closed” status.
Procedure for Newborn Applications when Parent is Active MPW or EWHS
Newborns born to mothers with an active MPW or EWHS case must be IAPP'd as a Newborn only application. If the mother has an open R case, enter a “2” next to the Newborn line on the IAPP screen. If the mother's current case is an R2, enter an “x” or a “1” next to the Newborn line.
NOTE: Newborn and MPW cases may now also be entered with a case designation of “R3.”
Example:
- Ms. Oliver is currently receiving EWHS on an R1 case. Her child is on a separate Newborn R2 case. Ms. Oliver comes in to apply for a new pregnancy. Worker will enter a “3” next to the General Relief line under the column “Type of Assistance.” The EWHS case cannot be changed to MPW as a separate MPW case must be registered for each pregnancy, and MPW applications must be registered to ensure timely approvals.
Clarification of Newborn Eligibility
The Social Security Act 1902(e)(4) provides automatic Medicaid eligibility to newborns that are born to a woman who is eligible for and receiving Medicaid on the date the child is born. Only approve children on “G” level of care if the mother was receiving federally-funded Medicaid on the date the child was born. Children of women who are eligible for prior quarter coverage and are born during the prior quarter eligibility period are not eligible for Newborn. See Family Healthcare Manual Section 0930.010.00 for the listing of qualified programs and exceptions.
Examples:
- Mrs. Jones is receiving CHIP Level of Care 2 for her two children, effective April 1, 2006. She is included (Z level of care) on the CHIP case, but not receiving Medicaid benefits in any program. Mrs. Jones reports the birth of her child, Emory, on April 30, 2006. Emory is not eligible as a Newborn as Mrs. Jones was not receiving federally-funded Medicaid on April 30. Evaluate Emory for MC+ for Children.
- Mrs. Sylvester applies for MPW on May 1. She is approved on May 15. She reports the birth of her child, Sally, born on May 10. Sally is not eligible as a Newborn as Mrs. Sylvester was not eligible for AND receiving federally-funded Medicaid on May 10.
- Ms. Jerri is active on Medical Assistance - Permanent and Total Disability (MA-PTD) Spenddown. She pays her Spenddown through Automatic Withdrawal. She reports the birth of her child, Tom, born on May 15. Tom is eligible for Newborn as Ms. Jerri was eligible for AND receiving federally-funded Medicaid on May 15. Open a Newborn case for Tom.
- Ms. Thomas and daughter Wendy receive MAF coverage from January 1, 2006 through July 26, 2006, when they are closed for failure to cooperate. In December 2006, the hospital reports the birth of Ms. Thomas' child Marlo, born June 1, 2006. Enter and approve Marlo as a Newborn, as Ms. Thomas was eligible for AND receiving federally-funded Medicaid when Marlo was born. Marlo remains eligible for Newborn coverage until she is one year of age, unless her mother has moved out of the state or Marlo no longer lives with Ms. Thomas.
“R” Case Identification
To help identify the type of “R” case (MPW, EWHS or Newborn), the following guide has been developed:
| CASE TYPE | LEVEL OF CARE | *SUB PROGRAM CODE(S) |
|---|---|---|
Medicaid for Pregnant Women (MPW) |
H or U |
12, 33, 34 or 35 |
Extended Women's Health Services (EWHS) |
O |
52 |
Newborn |
G |
51 |
NECESSARY ACTION:
- Effective immediately, approve Newborns (“G” babies) on a separate Newborn case.
- Review this memorandum with appropriate staff.