Page 15

• The child dies.

Newborn coverage continues regardless of whether the infant continues to live with the birth mother or whether the child ever lived with the birth mother in the case of adoption or other custody arrangement. However, if the child is adopted and the names and location of the adoptive parents are unknown, the child can only be covered for the duration of the hospitalization starting with the month of birth. If the infant has not been named, the name assigned to her/him by the hospital for identification purposes should be used.

Information sufficient to enroll the infant in the Newborn category is the child's name, sex, tax filing status and date of birth. Birth notification may be made by the parent; however, notification is also to be accepted from the hospital, authorized representative in the case, medical provider or Hoosier Healthwise health plan that can knowingly provide the required information.

Note: The tax filing status must be entered for newborns (Refer to 2418.00.00) When the 12-month Newborn coverage period expires, eligibility under other medical categories must be explored and verified. The child was deemed to have applied at birth, and therefore an application cannot be required in pursuing a category change.

Newborn coverage does not extend to babies born to mothers covered under the MA 10 category (Hoosier Healthwise Package C). However, upon request by the parent/caretaker or other notification of the birth, an application is to be immediately provided or mailed to the family, or information given about obtaining an application from the internet. Hospitals and other Indiana Medical Providers that are Hoosier Healthwise enrollment centers should be encouraged to take the applications for newborns. They will know the eligibility status of the mother by using their Eligibility Verification System, which will indicate the benefit package of the mother.

2225.20.00 REMOVING AN INDIVIDUAL FROM THE CASE

Individuals who leave a case and do not have any open Medicaid benefits do not need to receive any notice of the change. If they are added to another case, see 2225.00.00 for guidance. Members with open Medicaid benefits must be immediately opened in their new case (Case 2) when they are removed from the case where they no longer live (Case 1).

If the member is removed from Case 1 and not opened in Case 2 right away, their benefits end, and they do not receive any notice or appeal rights. This can lead to a member unexpectedly being turned away at doctor’s offices or at the pharmacy and must be avoided. Correcting the case later, while appropriate to do once we learn of such an error, still opens the member up to hardship during the time they remain closed.

Because Medicaid assistance groups only have one eligible member, a person with Medicaid who leaves the case should never be closed for that reason alone. Even if the member who left is a child and the worker does not know all the household members in the new case or