Children of Non-citizens or Ineligible Immigrants

SMHB ME Codes Effective July 1, 2022

Children of SMHB recipients who were denied MPW due to citizenship will receive a level of care based on the income at the time of the SMHB approval.

ME 6S (formerly ME 62) is for children born to SMHB mothers who were at or below 196% of FPL (201% with the 5% disregard) at approval.

ME 9S (formerly ME 74 and 75) is for children born to SMHB mothers who were above 196% of FPL and below 300% of FPL (between 201% and 305% respectively, with the 5% disregard) at approval.

EXAMPLE : Jane applied for coverage for her pregnancy on January 10. Jane is not a US citizen or eligible immigrant. She was denied for MPW and approved for SMHB. Jane’s child was born February 19. Current records show that household income is 190% of FPL. The child is eligible for SMHB-Newborn (ME 6S). Before the child’s first birthday, the household will be re-evaluated and the child moved to the appropriate level of care.

SMHB ME Codes Effective January 1, 2016 through June 30, 2022

Children of SMHB recipients who were denied MPW due to citizenship will receive the appropriate level of care for their reported household income based on the income at the time of the SMHB approval. (ME code 62, 74, or 75) A Federal Grant Indicator (FGI) of 8 will show as a “C” on MXIX, and show $0 premium, if appropriate.

EXAMPLE : Jane applied for coverage for her pregnancy on January 10. Jane is not a US citizen or eligible immigrant. She was denied for MPW and approved for SMHB. Jane’s child was born February 19. Current records show that household income is 190% of FPL. The child is eligible for Child Under 1 (ME 62). The FGI of 8 (shown as a C in the TOC field on MXIX) indicates the child is SMHB until age one. Before the child’s first birthday, the household will be re-evaluated and the child moved to the appropriate level of care.

An ex parte review must be completed before the child turns age one (1).