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: WHEN
 
IS
 
COVERAGE
 
FOR
 
ELIGIBLE
 
NEWBORNS
 
EFFECTIVE? Answer: Enrollment
 
with
 
a
 
health
 
plan
 
will
 
be
 
retroactive
 
to
 
the
 
first
 
day
 
of
 
the
 
month
 
of
 
birth. Health
 
plan
 
assignment
 
will
 
be
 
based
 
on
 
the
 
mother’s
 
choice
 
or
 
the
 
auto
 
assignment
 
algorithm. If
 
the
 
mother
 
is
 
enrolled
 
with
 
a
 
health
 
plan,
 
the
 
newborn
 
would
 
be
 
assigned
 
to
 
the
 
mother’s
 
plan. If
 
the
 
mother
 
is
 
Medicaid
 
Direct,
 
and
 
no
 
choice
 
is
 
made,
 
the
 
newborn
 
would
 
be
 
auto-assigned
 
to
 
the
 
health
 
plan
 
of
 
the
 
closest
 
family
 
member
 
or
 
other
 
parameters
 
in
 
the
 
auto
 
assignment
 
algorithm. Auto-
assignment
 
is
 
based
 
on
 
1)
 
where
 
the
 
beneficiary
 
lives,
 
2)
 
whether
 
he
 
or
 
she
 
is
 
a
 
member
 
of
 
a
 
special
 
population,
 
3)
 
historical
 
provider-beneficiary
 
relationship,
 
4)
 
health
 
plan
 
assignments
 
of
 
other
 
family
 
members,
 
and
 
5)
 
previous
 
health
 
plan
 
enrollment
 
within
 
the
 
past
 
12
 
months. Fact
 
Sheets
 
will
 
be
 
updated
 
periodically
 
with
 
new
 
information. Created
 
October
 
2019. For
 
more
 
information,
 
please
 
visit
 
https://www.ncdhhs.gov/assistance/medicaid-transformation
 
NC
 
Medicaid
 
2
 
of
 
2
 
20190115
 
v1.0