1860.010.00 Eligibility – DSS Manuals

IM-84 May 21, 2019 ; IM-152 November 30, 2017 ; IM-125 December 31, 2013

A child born to a woman eligible for Title XIX MO HealthNet on the date of the child’s birth continues to be eligible for MO HealthNet throughout the first year of life. This provision applies in instances where the birth occurred prior to the date of application and the woman was covered by MO HealthNet based on retroactive eligibility. Examples of retroactive eligibility would include a woman whose child is born during the three months prior to the month of application and the woman is determined eligible for the prior quarter after the child’s birth, or a child is born in the month of application and the woman is determined eligible for MO HealthNet coverage from the first day of the month of application.

There is no requirement that the child remain in the mother’s household or that the mother must remain eligible for MO HealthNet.

Newborn policy applies to children whose mother was participating, or retroactively eligible to participate, in a federally-funded MO HealthNet program identified in Appendix H – ME Codes Chart .

NOTE: Participants determined eligible as MHABD spend down (ME codes 11, 12, 13) must have the spenddown met by the date of the child’s birth in order for the child to receive newborn coverage.

EXAMPLE: A pregnant woman was approved on April 10 for MHABD spend down. The baby was born May 3. The mother’s spenddown was not met until May 9. The child is not eligible for newborn as the mother was not eligible for MO HealthNet on the date of the child’s birth.

Refer to 1855.030.05 Coverage for the Child After Birth for coverage of SMHB Newborns.