Newborn Medicaid is also part of ARKids A. The Deficit Reduction Act (DEFRA) of 1984, as amended by OBRA of 1990, requires that 12 months of Medicaid coverage be given to infants born to Medicaid eligible women, provided the mother remains Medicaid eligible or would be Medicaid eligible if she were pregnant, and the infant resides with the mother.

For newborn coverage to apply, the mother must be certified Medicaid eligible at the time of birth of the child, or later be determined Medicaid eligible for the birth month. If a mother is approved after the child's birth for retroactive coverage for herself, eligibility for the newborn may be

Requirements for 12 months of newborn coverage are:

    1.   Arkansas residency at birth of the child, and continuing Arkansas residency;

2. Certified Medicaid eligible mother at birth of the child or the mother is determined Medicaid eligible for the birth month after the child is born.
3. Mother must remain Medicaid eligible (or continue to be eligible if she were still pregnant); and
4. Child must continue to reside with its mother.

There are no Social Security enumeration, income or resource requirements to be considered for initial newborn eligibility. If the infant is born to a Medicaid eligible mother and will live with the mother, newborn coverage must be granted.

A referral to the Office of Child Support Enforcement (OCSE) is not an eligibility requirement for newborn coverage. Referrals to OCSE are completely voluntary in this category.

Hospital and physician providers may refer children born to Medicaid eligible mothers using a Hospital/Physician Referral Form for Newborn Coverage (Form DCO-645). The referring hospital/physician provider is requested to complete and mail the DCO-645 to the DHS County Office of the mother's residence within five days of the child's birth, when possible.

The DCO-645 will serve as verification of the birth date of the child as well as documentation of relationship.

On the day a DCO-645 is received by the county, it will be registered, as if it were a completed application, in Category 52 (Newborn) or Category 63 (SOBRA Newborn). Date of application will be the date the DCO-645 is received. If the application is received more than 3 months after the baby's birth, the baby's date of birth will be the application date. If vital information (e.g., DOB or name) in either Part I or Part II of the form is missing, the form will not be registered but will be returned to the provider within five working days from date of receipt, with a note to indicate what missing information is needed. If the mother of the child is not Medicaid eligible and has not made application for Medicaid, the DCO-645 will be returned to the provider with the notation in Part III of the form that "The mother has not applied for Medicaid for herself; therefore, we cannot determine newborn eligibility for the infant at this time." No further action is required of the county in this situation.

If there is a pending Pregnant Women (PW) application for the mother when a DCO-645 is received, the DCO-645 will be held by the county until disposition is made of the mother's PW application, at which time the county will notify the provider by completing Part III of the form and returning it to the provider. The county should inform the provider within 5 days that eligibility for the mother is pending.

If all vital information is on the form when received, if it is verified that the mother was Medicaid eligible at time of delivery, and the county has determined that the child lives with the mother, a newborn certification will be made within twenty working days from receipt of the completed DCO-645. The caseworker must then complete Part III of the form and return it to the provider within the twenty-day period.

If the newborn can (or must) be added to an existing case, necessary action should be taken to obtain an application, determine eligibility and add the infant to the case within the twenty working day time frame, without completing a certification in a newborn category. In the event the county is unable to complete the certification process to an existing case by the twentieth working day, the infant must be approved in a newborn category.

NOTE: Neither a DCO-645 nor an application form are required forms for initial certification of newborn coverage. A newborn case may be certified without a DCO-645, other formal referral, or application as long as the county has all the necessary information and has determined that the newborn requirements have been met. When newborn coverage is requested, whether or not there is a signed application or DCO-645 referral, a register number can be obtained and the request processed as a certification or a denial.

For newborn coverage to continue for the full 12-month period, the newborn must continue to reside with the mother, and the mother must remain certified Medicaid eligible or be presumed Medicaid eligible if she were still pregnant.

Once certified as Medicaid eligible, the newborn cannot lose eligibility due to increases in income or resources during the 12-month period. Because future income increases are disregarded, any certified Medicaid eligible mother of a newborn infant who loses Medicaid eligibility due to termination of a pregnancy or for other reasons, would be deemed eligible, if still pregnant. This rule will apply regardless of the category in which a mother was certified at birth of the infant (PW, U-18, SSI, TEA Related Medicaid, etc.). Although the mother would have to continue to be under the resource limit for her family size for her Medicaid eligibility to continue if she were still pregnant, increases in resources will not affect the eligibility of the newborn.

The newborn coverage may be terminated only if the child no longer resides with the mother, if the mother and child move out of state, or if the child is certified in another category.

If the mother was a certified Medicaid eligible recipient or was later determined Medicaid eligible for the birth month in any category, Medicaid coverage of the child will be provided as follows:

1. If the newborn can be (or must be) added to an existing case, necessary action should be taken within twenty working days to obtain an application, determine eligibility, and add the infant to the existing case. The DCO-645 may also be used to add the newborn to an existing case. However, if the DCO-645 is used, proof of application for a Social Security number must be provided ([Re. MS 1390, #2, b.]). If the child is not (or cannot be) added to any existing case within twenty working days, the caseworker will register the application in a newborn category with the parent as casehead. The date of application will be the date the DCO-645 or application is received in the county office, or in those instances where a DCO-645 or application form was not received, the date the county received a request for newborn coverage.

Note: If an application, or request, is received more than 3 months from the date of the baby's birth, the date of application will be the baby's date of birth.

2. Secure information necessary to open a Newborn Medicaid case.

3. Determine that the child lives with the mother. The mother’s declaration on the DCO-645 that the child will be living with her will be accepted. If the newborn will not be living with the mother upon dismissal from the hospital, i.e., will be adopted, Newborn coverage will only be granted until the mother has relinquished her parental rights, which in Arkansas is 10 working days after signing the adoption consent form.

5.  A DCO-700 or DCO-55 will be sent to the newborn's mother to notify her of the Newborn certification (or denial, if applicable). The mother should be advised to report all address changes for her family, and that she may reapply for Medicaid in another category when the newborn's eligibility has expired. The Newborn case record will consist only of the DCO-86, DCO-645 (if one was received) and DCO-700.

NOTE: Newborn coverage will be granted to an infant whose mother was certified in Presumptive Eligibility (Category 62) at the time of delivery. However, if the mother is subsequently found NOT eligible for full Medicaid benefits in another category for the period that covers the delivery, the Newborn coverage must end at the expiration of the Presumptive Eligibility period. The 12-month coverage will not apply in this case because the mother is not Medicaid eligible at the birth of the child.

Retroactive coverage to the date of birth may be granted if Newborn coverage for a child born to a certified Medicaid eligible mother or to a mother who is later determined to be Medicaid eligible in the month of birth is requested within 1 year (365 days) of the date of birth.

MS
Manual
04/01/04

Newborn coverage ends at the child's first birthday.  However, a DCO-975, ARKids First Annual Renewal Notice and Eligibility Report Form, will be system-generated to the family at the end of the 10^th month following the birth of the newborn.  If the DCO-975 is completed and returned the Newborn case will be transitioned to a regular ARKids A or B case, if eligible.  The information provided on the DCO-975, as well as the information on the mother's original PW application, will be used to make a determination for regular ARKids A or B.  If eligible in a regular ARKids A category, the Newborn case will be closed, with adequate notice, and the regular ARKids case will be approved.  If eligible in ARKids B, the child will be entitled to the full Newborn coverage until the child’s first birthday.  Notice will be sent to the family explaining the decreased coverage, and the child will be approved for ARKids B beginning the day after Newborn coverage ends.  If the child will not be eligible in a regular ARKids A or B category, the Newborn case will remain open until the system closes the case at the end of the 12-month period. 

If there are siblings open in an ARKids category, the child will be added to the existing case if appropriate.

If the DCO-975 is not returned, the caseworker will mail a manual DCO-975 along with a DCO-700 to the casehead.  The casehead will be advised that a completed DCO-975 must be received by the county office within 15 days or the child’s coverage will end one year from the child’s date of birth.

MS
Manual
04/01/04

16235 Closures

If the DCO-975 is not returned, the Newborn case will close automatically by the system at the end of the 12-month period.

The Newborn case will be closed if the newborn is added to another Medicaid case.  If the mother does not add the child to another case, the Newborn case will remain open for the full 12-month period, if appropriate. 

If a newborn has been certified in different cases during the 12-month period (e.g., initially certified in Newborn, then changed to TEA Related Medicaid, then converted to Transitional Medicaid, and then back to Newborn), the system will still check the category for expiration of the 12-month Newborn eligibility based on the child’s date of birth.