Page 7

COMAR 10.09.24.04

306 State of Maryland Medical Assistance Manual Revised July 2012

Requirement: Baby must reside in Maryland

If the newborn is added to a TCA AU (coverage groups F01-F03), the newborn’s eligibility may be affected by a change in circumstances of any family member; including the newborn, which makes the TCA AU ineligible. Then, each AU member, including the newborn, must have their MA eligibility determined for the most appropriate coverage group. The newborn’s automatic eligibility in the TCA AU is also lost if the newborn ceases living with the mother. Upon expiration of the newborn’s presumptive eligibility period, a redetermination must be conducted to determine the child’s continued eligibility, applying regular policies and procedures. Timely redeterminations are required to assure that coverage is not continued inappropriately. Eligibility factors pertaining to the newborn which could not be considered during the 15-month presumptive eligibility period must be considered at this time. A MA ineligible child must be considered for possible coverage under MCHP.

(1) Certification Procedure for the Newborn

Certification of a NB on MA master file is initiated by the DHMH office of Eligibility Services (OES). This procedure expedites certifications of newborns and must be followed by both hospital and LDSS/LHD. The procedure is as follows:

OES is notified by hospital via the DHMH form 1184(Hospital report of NB), that a child has been born to a mother who is a MA or MCHP recipient. OES certifies NB on MA Eligibility Verification System (EVS) master file using the mother’s case number to establish a temporary case number until the CARES interface assigns a permanent case number for the child. Therefore, the child will not have a CARES IRN at this point. OES sends a completed 1184 to LDSS/LHD, as appropriate, for eligibility processing Upon receipt of an 1184, the LDSS/LHD case manager must make determinations on their own: a. Was the mother eligible for the date of the NB birth b. If eligible, add the NB to the mother’s AU# (add program/add person- more members). c. Review the 1184 for any errors or inconsistencies (name, address, eligibility, dates, category codes, etc) and take necessary corrective action as needed d. If there is a discrepancy between the CARES and MMIS as to whether the mother was MA/MCHP eligible for the date of the child’s birth, the LDSS/LHD case manager reviews the case record to determine the correct eligibility status and then takes the appropriate action. e. If mother’s eligibility ends, the baby (PO3) will received MA for 15 months. f. Note: No application is needed to add the NB g. If the mother gives up legal custody of the NB and the child does not go home with the mother, the NB does NOT automatically qualify for the MA/MCHP. The caretaker for the child would have to apply for the child