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Chapter: 2000 Coverage Groups Program: MSSI, SFP 10 the agency suggests the individual’s circumstance may have changed in the retroactive period. 2030.0812.03 Date of Entitlement for Retroactive Medicaid (MFAM) The period of entitlement for each retroactive month is the calendar month for which eligibility is established; that is, if the individual is determined to be eligible for any day in a month, he is eligible for the full calendar month, except for Medically Needy. Medicaid eligibility in the Medically Needy Program is determined by the day the individual meets their share of cost. 2030.0900 CHILDREN’S COVERAGE GROUPS (MFAM) The following sections describe coverage groups available for children up to age 21. A child is Medicaid eligible for the entire month of their birthday, unless the child was born on the first day of the month, in which case eligibility for Medicaid terminates on the first day of the child's birth month.

Exception: If the child is hospitalized the day Medicaid coverage is scheduled to end and the child has not yet exhausted all inpatient days, the child will remain eligible through the month of discharge from the hospital. If doctor visits occur after the hospitalization has ended as part of the follow up, additional months of Medicaid coverage may need to be authorized. 2030.0901 Infants Under Age One (MFAM) A newborn is presumed eligible for Medicaid through the birth month of the following year when born to a mother eligible for Medicaid on the date of the child's birth, including a mother on Emergency Medical Assistance for Noncitizens. The child remains eligible for Presumptively Eligible Newborn (PEN) coverage as long as the child remains a resident of Florida or until the child’s death. If the child was born on the first of the month, PEN eligibility ceases effective the birth month. All newborns are considered to be living with the mother the month of birth.

Eligibility for PEN does not apply to a child born to a parent receiving Presumptively Eligible Pregnant Woman (PEPW) coverage only. If a PEPW woman is later determined eligible for regular Medicaid for the month of delivery, the child will be PEN eligible.

If the mother is Medically Needy and meets her share of cost on or before the date of birth, the child is eligible for presumptive coverage.

Notification of birth may be received from the Medicaid provider or from the parent(s). All PENs must be added to Medicaid within five days of notification of their birth. No application or face-to- face interview is required for PEN coverage.

A Medicaid notice of case action must be sent with the newborn’s Medicaid number to the parent stating the following information: “Medicaid is being authorized for up to one year from the date of the child’s birth”. This will serve as the 10-day advance notice unless the case is canceled prior to the end of one year.

No verification of U.S. citizenship or identity will be needed for these children, even after the presumptive period ends. 2030.0902 Children Under Age 19 (MFAM) When a child who meets the technical criteria for residency, age, identity and citizenship/noncitizen and the tax household’s income is at or below the income limit for the coverage group, the child is eligible for Medicaid. If the income is higher than the income limit, the child may be enrolled in Medically Needy and/or referred to the Children’s Health Insurance Program (CHIP) or the Federally Facilitated Marketplace (FFM).