(C) Eligibility criteria
for coverage because a newborn child was born to a medicaid-eligible woman
(deemed newborn). In accordance with
42 C.F.R.
435.117 (as in effect
October
1, 2020), a child is automatically eligible for
medical
assistance as of the child's date of birth, and remains eligible until
the child reaches the age of one, provided the birth mother has applied for,
been determined eligible for, and is receiving medical
assistance on the date of the child's birth.
(1) Coverage under this paragraph also
applies to newborns under the following circumstances:
(a) When labor and delivery services were
furnished prior to the date of application and the birth mother's medicaid
eligibility is based on retroactive coverage in accordance with
42 C.F.R. 435.915
(as in effect October 1, 2020).
(b)
When the birth
mother is receiving alien emergency medical assistance (AEMA) in accordance
with rule
5160:1-5-06
of the Administrative Code.
(c)
When the
birth mother is residing in a public institution and is:
(i) Restricted from payment of services as
referenced in rule
5160:1-1-03
of the Administrative Code; and
(ii) Within twelve months
of the
date of her most recent medicaid application or renewal.
(d)
When the birth
mother is in the custody of a public children services agency (PCSA) or private
child placing agency (PCPA).
(e)
When the
birth mother is in receipt of adoption or foster care assistance under Title
IV-E.
(f)
When the
birth mother is in receipt of state or federal adoption assistance.
(g) When the birth mother loses medicaid
eligibility after the birth of the newborn.
(h) When the birth mother is no longer a
member of the newborn's household at any time prior to the newborn reaching the
age of one.
(2) For
newborns described in this paragraph, the administrative agency must:
(a) Upon verbal or written notification of
the newborn's birth from any individual or entity reporting the birth:
(i) Verify, in the electronic eligibility
system, that the birth mother was eligible for and received medicaid on the
date of the child's birth, and
(ii)
Approve the child's eligibility for medicaid without delay and without
consideration of household composition or income.
(b) Not require an application for the child
or a renewal of eligibility prior to the month of
the child's first birthday.
(c) Not
require verification of U.S. citizenship or identity.
(d) Complete a renewal
of eligibility when the child reaches the age of
one.
