|
Effective: March 1, 2010 |
|
|
03.25.10ar5 - Medical Assistance (MA) for Auto Newborns (Archive) |
Archived: September 1, 2010 |
All children born to women who applied for Medical Assistance (MA) before or after the birth and were enrolled in MA for the birth month are automatically eligible and remain eligible for MA through the month of their first birthday as long as the child continues to live with the mother in Minnesota. This includes women who were eligible for federally funded MA (program MA), state-funded MA (otherwise known as NMED ), or Emergency Medical Assistance (EMA) (program EH) at the time of birth.
Note: The age limit for auto newborn eligibility changed from age two to age one effective July 1, 2003.
Continued eligibility as an auto newborn is not dependent on the mother's continued eligibility, as long as the child meets the above criteria. This includes children born to women who applied after the birth and were made eligible retroactively to the date of birth or before.
Example:
Christine is enrolled in MA under a pregnant woman basis when she gives birth to Moses. At the end of the 60-day postpartum period, Christine is not eligible under any other basis due to excess income and her MA is closed.
Action:
Continue MA eligibility for Moses through the month of his first birthday, as long as he continues to live with Christine in Minnesota.
In addition to children whose mothers were eligible for MA (including NMED or EMA) at the time of birth, this basis includes children born to women who were enrolled in MinnesotaCare (programs LL or KK) for the birth month, if the mother chooses MA rather than MinnesotaCare for the child.
Example:
Brad and Sandra are enrolled in MinnesotaCare with their two children. Sandra is pregnant and enrolled in program LL. They have a baby on November 2 and choose to enroll the baby in MA instead of MinnesotaCare.
Action:
Approve MA eligibility for the baby as an auto newborn through the month of the first birthday.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
For health care-only cases, do not require an addendum for the newborn. Obtain the child's name and birth date and document the information in the case record.
Note: Do not require a name as a condition of adding a child for whom the mother has relinquished care or control.
Example:
Sheila is an MA enrollee and gives birth to a son on March 23. She signs papers relinquishing control of the child to an adoption agency on March 24. She does not name the child. The health plan confirms the birth date.
Action:
Add the child to Sheila’s case as an auto newborn effective March 1. Remove the child effective April 1, the first full month in which he lives apart from Sheila. If the child requires continued MA, a representative of the adoption agency or other responsible person may apply on his behalf. See Authorized Representatives. The adoption agency is not responsible for the cost of the baby’s medical care.
All children born to a woman enrolled in MA are eligible on the mother’s case as auto newborns for the month of birth, including children who are placed for adoption immediately.
Note: See service delivery below for an exception in case the mother does not want MA eligibility for the child.
If you are unable to contact the mother to determine if she wants continued MA for a newborn, add the child for the birth month only.
l Send a notice to add the child for the birth month and a notice to remove the child the following month.
l If the mother contacts the county later requesting continued coverage for the child, reinstate MA for the child back to the date of removal if the child has continued to live with the mother.
Example:
Rhonda is a GAMC enrollee. The worker receives notification that she had a pregnancy-related medical claim.
Action:
Confirm and verify the pregnancy and open MA for Rhonda under a Pregnant Women basis.
On August 10, the health plan notifies the county agency that Rhonda had a baby boy on August 2. The worker attempts to contact Rhonda by phone on August 12 and leaves a message asking Rhonda to call by August 22. Rhonda does not respond and the worker makes a second attempt asking Rhonda to call by September 3. Rhonda has not contacted the worker by September 20.
Action:
Add the newborn to Rhonda’s MA for the month of August only. Send a notice to Rhonda’s last known address advising her that the newborn has been added to MA effective August 1 and removed effective September 1.
Note: If Rhonda calls asking for continued coverage for the baby, reinstate MA effective September 1, if the baby continues to live with Rhonda.
Renewals (standard guidelines)
Auto newborns are exempt from six-month and annual renewal requirements through the month of their first birthday. See End of Eligibility in Basis below for further information.
No verifications are required for auto newborns.
Social Security Number (standard guidelines)
Children eligible as auto newborns are not required to apply for or provide a SSN through the end of the month of their first birthday.
Children eligible as auto newborns are generally U.S. citizens because they were born in the United States, regardless of the mother's citizenship or immigration status.
MA and MinnesotaCare auto newborns are exempt from citizenship and identity documentation requirements. Do not require documentation of citizenship and identity for currently enrolled auto newborns
Do not require citizenship and identity documentation for applicants and enrollees who were previously eligible as auto newborns.
Example:
Marike is an LPR who is eligible for NMED rather than federally funded MA due to her date of entry into the U.S. She gives birth to Odin on October 12. Odin is a U.S. citizen.
Action:
Approve federally funded MA for Odin through the month of his first birthday as long as he continues to live with Marike in Minnesota. Do not require verification of Odin’s citizenship. Auto newborns are exempt from the requirement.
Residency (standard guidelines)
Close MA if the child and mother move out of Minnesota. If the mother and child return to live together in Minnesota before the end of the auto newborn period, the child regains auto newborn status as of the date the mother and child regain Minnesota residency.
Example:
Janet is an MA enrollee and gives birth to Amanda on August 4. Janet and Amanda move to Indiana on October 10.
Action:
Terminate MA effective November 1.
Janet and Amanda move back to Minnesota the following June 16 when Amanda is 10 months old. Janet is not MA-eligible.
Action:
Approve Amanda’s MA eligibility as an auto newborn from June 16 through August (the month of her first birthday).
Note: If Amanda was on MA in Indiana, see Moving to Minnesota for procedures to coordinate her eligibility between the states.
When the birth of an auto newborn is reported, ask the parent or caretaker about health insurance that may be available to the child and pursue cost effective insurance premium payments if appropriate.
l If you are unable to reach a parent or caretaker by phone, mail the Minnesota Health Care Programs Health Insurance Information form (DHS-1922B) with a cover letter (DHS-4599).
l Record all pertinent information in case notes.
Note: Do not take an adverse action against a child if the parent or caretaker fails to cooperate.
Household Composition (standard guidelines)
Consider the child to live with the mother through the 60-day postpartum period even if the child remains in the hospital after the woman's discharge.
If the child leaves the hospital but lives apart from the mother for more than one full calendar month, redetermine the child's eligibility using only the child's income, starting with the first full calendar month apart. See Steps to Removing a Person From the Household and Steps to Adding an MA/GAMC Household Member.
Example:
Barbara gives birth to Matthew on August 12. She is discharged from the hospital on August 14. Matthew remains hospitalized until October 16 due to medical problems. On October 16, Matthew leaves the hospital and goes to live with Barbara’s mother.
Action:
Consider Matthew eligible as an auto newborn on Barbara’s case through October. Remove Matthew from Barbara’s case effective November 1. Redetermine Matthew's eligibility under his grandmother's case or establish a new case and request the needed forms and verifications from his grandmother to determine eligibility.
Note: If Matthew returns to live with Barbara before his first birthday, he regains auto newborn status through the month of his first birthday.
Not applicable - there is no income or asset test, so no evaluation method is needed.
Asset Guidelines (standard guidelines)
There is no asset limit for auto newborns.
There is no income test for auto newborns.
There is no income test for auto newborns.
Spenddowns (standard guidelines)
There is no income test for auto newborns.
Children under age 21 do not have or dental limits.
If the mother was enrolled in managed care for the birth month, enroll the auto newborn retroactively in the same health plan as the mother back to the birth month, unless the newborn meets an exclusion. Document the exclusion in case notes.
Exception: If a parent does not want MA eligibility for the auto newborn, there is no requirement that MA be approved just to pay a health plan for the birth month. If parents decline MA for an auto newborn:
l Ask the parents for a written statement that they have declined MA coverage.
l Tell the parents that they may be responsible for any bills.
l Document that the parents have declined MA coverage for the auto newborn, and the reason, in case notes.
If the mother legally relinquishes control of the child before the child leaves the hospital, consider the child to be out of the mother's household starting with the first full calendar month for which you can give 10-day notice after papers are signed giving custody and control of the child to an agency or person other than the mother. This could be a pre-adoptive placement or foster home placement of any duration. The most common documents used to change custody and control in these situations are the Voluntary Foster Care Placement Agreement, the Agreement Conferring Authority to Place Child for Adoption, or a court order. Do not require the enrollee to provide a copy of these documents.
Redetermine eligibility using only the child's income. See Household Composition above for further information. Continue basing eligibility on only the child's income until either of the following occurs:
l The child is legally adopted. Begin deeming the adoptive parents' income starting with the first full calendar month after the adoption is finalized, unless the child receives adoption assistance.
l Legal custody and control of the child is returned to the mother. At that time, the child would again become automatically eligible through the end of the auto newborn period.
Example:
Anne gives birth to Morgan on May 2 and voluntarily places him in foster care. Morgan qualifies for Title IV-E foster care funding.
Action:
Add Morgan to Anne’s MA case effective May 1 and remove him effective May 31. He has MA eligibility approved as a foster child effective June 1.
Morgan returns to Anne’s care and custody on September 5.
Action:
Morgan regains auto newborn status. Remove him from the foster care case and add him back to Anne's MA case effective October 1.
Assess continued MA eligibility before terminating the child’s coverage at the end of the auto newborn period. Require a renewal if no one in the household has completed a renewal within the past 12 months.
If a child eligible as an auto newborn is part of a household that loses eligibility for MA under another basis, such as TMA/TYMA, continue the child’s eligibility as an auto newborn through the month of the child’s first birthday.
Example:
Renee gives birth to a son, Greg, while receiving MA. When Greg is six months old, Renee’s earnings increase and she now has a spenddown. She is eligible for TYMA.
Action:
Continue Greg’s eligibility as an auto newborn during the TYMA period, through the month of his first birthday. If Renee is still eligible for TYMA after Greg's auto newborn status ends, approve Greg for TYMA starting the month after the month of his first birthday.
Note: If Renee is no longer eligible for TYMA, redetermine Greg’s eligibility under another basis.
Children who are eligible as auto newborns on MA are also eligible as auto newborns on MinnesotaCare. The mother may choose to receive coverage for the child through MinnesotaCare instead of MA at any time between the child’s birth and the month of the child’s first birthday.
All children have a basis of eligibility for MA as children under age 21.
Workers who have contact with families during the application process are encouraged to inform families that the Child and Teen Checkups Program (C&TC) is an MA benefit, and that the county C&TC agency will contact them with more information.