Title: 
Headings:  Eligibility for Newborns:  What Providers Need to Know
Eligibility
 
for
 
Newborns:
  
What
 
Providers
 
Need
 
to
 
Know
 

Eligibility
 
Requirements
 
for
 
Newborns
 

NEWBORN
 
PLAN
 
ASSIGNMENT
 

NEWBORN
 
ENROLLMENT
 
AND
 
TRANSITION
 
OF
 
CARE
 

NCTRACKS
 
INFORMATION
 
ON
 
NEWBORNS
 
FOR
 
PROVIDERS
 

BILLING
 
CONSIDERATIONS
  

HOW
 
WILL
 
NEWBORN
 
CLAIMS
 
BE
 
HANDLED
 
IN
 
THE
 
HOSPITAL
 
IF
 
THE
 
ATTENDING
 
PEDIATRICIAN
 
DOES
 
NOT
 
PARTICIPATE
 
IN
 
THE
 
NEWBORN’S
 
HEALTH
 
PLAN?
 

WHAT
 
IF
 
THE
 
MOTHER
 
IS
 
ELIGIBLE
 
ONLY
 
FOR
 
EMERGENCY
 
PREGNANCY
 
MEDICAID
 
COVERAGE?
    

WHAT
 
IF
 
THE
 
MOTHER
 
IS
 
NOT
 
ELIGIBLE
 
FOR
 
MEDICAID?
 
CAN
 
THE
 
NEWBORN
 
RECEIVE
 
MEDICAID?
 

HOW
 
ARE
 
NEWBORNS
 
ASSIGNED
 
TO
 
A
 
MEDICAID
 
MANAGED
 
CARE
 
HEALTH
 
PLAN?
  
WHEN
 
IS
 
COVERAGE
 
FOR
 
ELIGIBLE
 
NEWBORNS
 
EFFECTIVE?
 


Content: Eligibility for Newborns: What Providers Need to Know
Playbook
 
2019
 
NC
 
Medicaid
   
Eligibility
 
for
 
Newborns: What
 
Providers
 
Need
 
to
 
Know
 
Eligibility
 
Requirements
 
for
 
Newborns
 

 
child
 
born
 
to
 
a
 
woman
 
receiving
 
Medicaid
 
that
 
covers
 
labor
 
and
 
delivery
 
on
 
the
 
date
 
of
 
the
 
child’s
 
birth
 
is
 
automatically
 
eligible
 
for
 
Medicaid. The
 
newborn
 
is
 
“deemed
 
eligible”
 
based
 
on
 
the
 
mother’s
 
Medicaid
 
coverage. The
 
certification
 
period
 
is
 
through
 
the
 
end
 
of
 
the
 
month
 
the
 
child
 
turns
 
1
 
year
 
of
 
age
 

 
child
 
whose
 
mother
 
is
 
not
 
covered
 
by
 
Medicaid
 
for
 
the
 
birth
 
of
 
the
 
child
 
may
 
be
 
eligible
 
for
 
Medicaid
 
or
 
NC
 
Health
 
Choice
 
for
 
Children. An
 
application
 
must
 
be
 
submitted
 
for
 
the
 
child
 
and
 
the
 
child
 
must
 
meet
 
all
 
eligibility
 
requirements,
 
including
 
income. The
 
local
 
county
 
department
 
of
 
social
 
services
 
determines
 
eligibility
 
the
 
same
 
as
 
for
 
any
 
Medicaid
 
applicant. All
 
information
 
contained
 
in
 
this
 
document
 
is
 
dependent
 
upon
 
the
 
actual
 
NC
 
Medicaid
 
or
 
NC
 
Health
 
Choice
 
status
 
and
 
managed
 
care
 
status
 
of
 
the
 
newborn. Nothing
 
in
 
this
 
document
 
supersedes
 
the
 
newborn’s
 
actual
 
official
 
status
 
according
 
to
 
the
 
records
 
of
 
the
 
NC
 
Department
 
of
 
Health
 
and
 
Human
 
Services,
 
Division
 
of
 
Health
 
Benefits. NEWBORN
 
PLAN
 
ASSIGNMENT
 
If
 
on
 
the
 
date
 
she
 
gives
 
birth,
 
the
 
mother
 
is
 
covered
 
by…
 

Newborn
 
is
 
covered
 
by…
 

Medicaid
 
Direct
 

Managed
 
Care
 
Health
 
Plan
 

Medicaid
 
Managed
 
Care
 
Health
 
Plan
 

Managed
 
Care
 
Health
 
Plan
 

NEWBORN
 
ENROLLMENT
 
AND
 
TRANSITION
 
OF
 
CARE
 
Q: