Rhode Island Code of Regulations
Title 210 - Executive Office of Health and Human Services
Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults
Subchapter 05 - Service Delivery Options
Part 2 - Medicaid Managed Care Delivery Options
Section 210-RICR-30-05-2.37 - Enrollment of Newborns and Adopted Children

1. Newborns - Infants born to mothers with income up to two hundred fifty-three percent (253%) of FPL who are enrolled in an MCO on the date of their baby's birth are automatically enrolled into a RIte Care MCO. If the newborn's mother is enrolled in a RIte Care MCO, the child is automatically enrolled in the mother's MCO. If the newborn's mother is enrolled in a RHP MCO, the baby and the mother will be enrolled in a RIte Care MCO, effective on the date of birth, once certification of the birth has been received. If the newborn's mother is enrolled in an ESI or other qualified health plan (QHP) with a Medicaid wrap, the baby is enrolled in RIte Care or RIte Share if the plan meets the cost-effectiveness test set forth in Part 3 of this Subchapter. §00-1.8(A) of this Chapter for newborn deeming provisions.

2. Adopted children - Enrollment of adopted children who are eligible on their own or as part of a Medicaid eligible family also varies depending on the basis of Medicaid coverage. Legally adopted children are enrolled as of the date the adoption becomes final. This date cannot be prior to the date Medicaid eligibility is established. The applicable provisions on eligibility and enrollment of child participating the State's adoption subsidy program are located in, Medicaid Affordable Care Coverage Groups Overview and Eligibility Pathways (Subchapter 00 Part 1 of this Chapter). A parent, caretaker or guardian must notify EOHHS when a newborn deemed eligible is adopted.

3. Other Infants and Children - All infants and children with income up to the two hundred sixty-one percent (261%) of the FPL level are Medicaid eligible under the MACC group for children and young adults, irrespective of the eligibility of a parent, caretaker or pregnant mother as indicated in the provisions in, Medicaid Affordable Care Coverage Groups Overview and Eligibility Pathways (Subchapter 00 Part 1 of this Chapter). Any infants and children determined eligible on this basis are enrolled in a RIte Care or, as applicable, RIte Share-approved ESI health plan in accordance with the provisions of this rule applicable to all other Medicaid members.