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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 July 2021 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.400 14

2. Newborn Child 42 CFR 435.117 - A child born to a woman who was eligible for Medicaid or to an individual covered by FAMIS at the time the child was born (including a newborn child born to an alien eligible for Medicaid payment of emergency services only) is eligible as a newborn child under age 1 year. Exceptions: A child born to a women enrolled under Hospital Presumptive Eligibility (HPE); an application must be submitted for the child’s Medicaid eligibility to be determined since no Medicaid application was submitted for the child’s mother. An infant born to a woman in FAMIS Prenatal Coverage who is enrolled in AC 111 and/or enrolled in managed care must be evaluated for ongoing coverage. The infant is not considered a deemed-eligible newborn. See Chapter M023. a. Eligible To Age 1 A child no longer meets this covered group effective the end of the month in which the child reaches age 1, provided he was under age 1 on the first day of the month. If the child was born on the first day of the month, his eligibility ends the last day of the month prior to the month he reaches age 1. Any child born a Medicaid-eligible woman will continue to be eligible up to age 1. If the child’s mother was covered by Medicaid as a categorically needy individual in a state other than Virginia at the time of the child’s birth, verification of the mother’s Medicaid coverage must be provided by the parent or authorized representative.

b. No Other Eligibility Requirements No other nonfinancial or financial eligibility requirements need to be met by the newborn child. C. Financial Eligibility Eligibility for CN Pregnant Women is based on the Modified Adjusted Gross Income (MAGI) methodology contained in Chapter M04. 1. Assistance Unit The unborn child or children are included in the household size for a pregnant woman’s eligibility determination. Refer to the procedures for determining the MAGI household in Chapter M04. 2. Resources There is no resource test. 3. Income Women enrolled as Pregnant Women are not subject to renewals during the pregnancy. The income limits for Pregnant Women are contained in M04, Appendix 2.

4. Income Changes After Eligibility Established a. Pregnant Woman Once eligibility is established as a pregnant woman, changes in income do not affect her eligibility as long as she meets the pregnant definition and the other nonfinancial eligibility requirements. This also includes situations where eligibility is established in the retroactive period.