400.17.01 DEEMED ELIGIBLE NEWBORNS

In accordance with 42 CFR 435.117, an infant born to a Medicaid-eligible mother is deemed to be Medicaid eligible from birth until the child’s first birthday, i.e., until the end of the month of the child’s first birthday. The infant is deemed to be eligible effective as of the date of birth without requiring a separate application and remains eligible regardless of changes in circumstances through the month of the child’s first birthday. Additionally: • An infant’s deemed eligible status will also apply when the pregnant woman applies after the birth of the child and is found to be eligible retroactively. • The deemed eligible newborn is not required to remain with the mother in order to be deemed eligible for Medicaid for the first year of life. • The deemed eligible newborn includes infants born to non-qualified immigrant mothers who are approved for Medicaid on the basis of emergency medical services in COE-021. • Only a terminating event such as the infant’s death, change of residency or voluntary request for closure of the child’s case by the parent/representative can result in the early closure of a deemed eligible infant. Deemed Newborn Enrollment Process There are 3-ways a deemed newborn may be enrolled in Medicaid: 1. The usual and customary process is the birthing hospital’s submission of the Newborn Enrollment Form directly to the Office of Eligibility within the Central Office. Eligibility staff adds coverage for the deemed infant and provides the Medicaid ID number to the birth hospital. If the infant has been added to the mother’s Medicaid case, the child’s eligibility will be reviewed for renewal at the end of the first year of life by way of a pre-populated review form sent to the mother or her representative. If parental rights were terminated at birth, as reported on the Newborn Enrollment Form, and the whereabouts of the child are unknown, the child’s eligibility will be allowed to close at the end of the month in which the child turns age one. 2. A child born to a Medicaid-eligible mother may also have Medicaid coverage added through the K-baby process, which is a claims-driven process that adds the baby directly to the MMIS without intervention by Eligibility staff. The newborn’s Medicaid ID number is generated by the K-baby process, which is available to providers via the web portal. If the child remains enrolled only through the K-baby process, the MMIS issues a “Notice of Medicaid Closure for Your Baby” (RB292) in the month prior to the child turning age 1 to notify the parent or caretaker that the child’s Medicaid is ending, and that action is needed to apply for continued coverage for the child. 3. Newborn Medicaid coverage may be added by Specialists in the Regional Office. RO’s primarily add newborns of immigrant mothers who are approved for Medicaid due to the receipt of emergency medical services via COE-021 approval. The RO adds the newborn at the time COE-021 emergency medical services are approved for the immigrant mother. A pre-populated renewal form is issued prior to the child turning age 1 so that eligibility can be evaluated for continued coverage. There are also instances when the RO will be responsible for deeming other newborns such as when a renewal or reapplication is pending for other family members. In this case, Central Office staff will send the Newborn Enrollment Form to the RO to handle with other case action.