Does My Newborn Qualify For Medicaid

Income Guidelines For Children’s Medicaid

Your income is the money you get paid before taxes are taken out. Find your family size on the table below. If your monthly income is the same or less, your child might get Children’s Medicaid.

*A family of one might be a child who does not live with a parent or other relative.

Health Insurance Options For You

• Medicaid: Free or very low cost insurance for New Yorkers with low income. Pregnant New Yorkers can qualify with higher income and regardless of immigration status.
• Private/Qualified Health Plans: Insurance plans on the NY State of Health Marketplace and directly from insurance companies. If you are pregnant, you can enroll outside of the open enrollment period on the NY State of Health Marketplace.
• Family Planning Extension Program: Program for people who have Medicaid while pregnant but who no longer qualify after their pregnancy.

Relevant Rule: Wac 182

• Newborn children may be enrolled in medical and dental coverage upon birth and adopted children may be enrolled when the employee assumes legal obligation for total or partial support in anticipation of adoption. If enrolling the newborn in medical and or dental coverage, the childs coverage will begin on the date of birth. If enrolling a newly adopted child, coverage will begin on the date of placement or the date a legal obligation is assumed in anticipation of adoption, whichever is earlier.
• If the employee previously waived medical coverage, he/she must enroll in medical to add an eligible dependent to medical coverage. Coverage for the employee begins the first day of the month in which the event occurs.
• To enroll a spouse or state registered domestic partner of an employee, coverage will begin the first day of the month in which the event occurs.

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Effective Date Of Coverage

Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.

What Are The Benefits Once The Child Is Born

• Two postpartum visits for the mother.
• Once a child is discharged from the initial hospital admission, the child receives the traditional CHIP benefit package, or Medicaid, depending on their income. CHIP or Medicaid benefits include regular checkups, immunizations and prescriptions for the baby after he or she leaves the hospital.
• Depending on income, the newborn may get Medicaid from birth to their 1st birthday. Most CHIP perinatal infants qualify for Medicaid. If the baby is eligible to get Medicaid, the mother will receive a letter and Form H3038-P, CHIP Perinatal Emergency Medical Services Certification, in the mail before delivery.

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Newborn Screening For Health Problems That Need Early Treatment

Some babies are born with health problems that can harm growth and development. Early treatment can keep babies healthy and further their development.

In New York State, all babies are tested at birth for seven health problems. To do this, a tiny blood sample will be taken from the baby’s heel before he or she goes home.

You will get your baby’s test results only if there is a problem. You may be asked to have your baby retested. Don’t panic. It’s more likely a problem with the blood test, not the baby.

See If Your Children Qualify And Apply For Chip

Each state program has its own rules about who qualifies for CHIP. You can apply right now, any time of year, and find out if you qualify. If you apply for Medicaid coverage to your state agency, youll also find out if your children qualify for CHIP. If they qualify, you won’t have to buy an insurance plan to cover them.

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Adding Your Newborn To Medicare

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Enrolling your newborn in Medicare will allow them to receive free or lower cost healthcare and prescriptions. Your baby will also get free treatment in a public hospital as a public patient. Here is some information to help you enrol your newborn in Medicare.

As soon as you add your baby to your Medicare card, they will have access to subsidised or free healthcare.

If your baby is 52 weeks old or less, you can register them using a Newborn Child Declaration form. This form is provided in the Parent Pack you get from your midwife or hospital. The back page of the form will need to be filled out and signed by the midwife or doctor who attended your babys birth. Submitting this form will automatically enrol your baby in Medicare. The form has instructions on how to fill it out.

You can upload your Newborn Child Declaration form using your Medicare online account. You will be sent a Medicare card with your baby on it in 3 to 4 weeks. You can get a digital version of the card straight away in the Express Plus Medicare app.

You can also enrol your baby using your Centrelink online account when you claim any one of these payments:

• Family Tax Benefit including Newborn Upfront Payment and Newborn Supplement
• Parental Leave Pay
• Dad and Partner Pay

You should fill in the Newborn Child Declaration form from your Parent Pack and submit it through either:

• your Centrelink online account through myGov
• your Express Plus Centrelink mobile app

Your Baby’s Medical Home

• How can I get the best health care for my child?

All babies need a “medical home.” A medical home is the doctor, nurse, physician’s assistant or healthcare team who takes care of your baby’s health as he or she grows and develops from an infant to a toddler, to a preschooler, and all throughout childhood and adolescence. A medical home is the place you always bring your baby for a check up or when your baby is sick. And, a medical home is the place where you go with questions and concerns about your baby’s health and development.

Health insurance is available for your baby and your older children, too. Children in your family who are 14 years of age or younger are eligible for Medicaid coverage if your family qualifies financially. All Medicaid-eligible children are provided with 12 months of continuous coverage, even if your family’s income exceeds eligibility levels during that period.

If you need health insurance to pay for your baby’s care, New York State’s Child Health Plus program can help.

Child Health Plus pays for:

• Regular visits to the doctor
• Visits to the doctor when your baby is sick
• Hospital care for your baby if needed.

To be eligible for Child Health Plus:

• You and your baby must live in New York State.
• Your family must either have insurance that doesn’t cover your baby’s needs or have no health insurance.
• Your children must be under the age of 19.

To find out more about Child Health Plus, call toll-free 1-800-698-4543.

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Ways To Apply For Chip:

• Fill out an application through the Health Insurance Marketplace®. If it looks like anyone in your household qualifies for Medicaid or CHIP, well send your information to your state agency. Theyll contact you about enrollment. When you submit your Marketplace application, youll also find out if you qualify for an individual insurance plan with savings based on your income instead. Create an account or log in to an existing account to get started.

FYI: Apply any time

You can apply for and enroll in Medicaid or CHIP any time of year. Theres no limited enrollment period for either Medicaid or CHIP. If you qualify, your coverage can start immediately.

Can Uninsured Women Enroll In Marketplace Coverage Upon Becoming Pregnant

Only if it is within the established open enrollment period or a woman qualifies for a special enrollment period , does not have a plan that meets MEC through Medicaid or an employer, and meets income and immigration criteria. Note that except in the states of New York and Vermont, pregnancy does not trigger an SEP.

Under the ACA, people who do not qualify for Medicaid coverage that meets MEC, and have incomes between 100% and 400% FPL, qualify for advance premium tax credits and cost-sharing reductions , which they can use to reduce the cost of health insurance purchased through a Marketplace. Those with pregnancy-related Medicaid in the three states that do not constitute MEC are eligible for Marketplace subsidies. Certain lawfully-present immigrants with incomes under 100% FPL subject to Medicaids five-year ban in their state are also eligible for APTCs. Undocumented immigrants are not eligible for APTCs, CSRs, or Marketplace insurance.

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How Much Does Medicaid Cover For Pregnancy

If you’re pregnant and enrolled in a Medicaid or CHIP plan, you’ll have coverage for prenatal medical care, labor and delivery and any medically necessary services you receive during that time. Federal regulations stipulate that all states must provide coverage for inpatient and outpatient hospital care during pregnancy. Other mandatory benefits include:

• Nurse midwife services

Newborn Screening For Chip And Chip Perinatal

Providers submitting newborn screening specimens to the Department of State Health Services laboratory use the NBS3: Medicaid/Charity Care/CHIP test card when screening babies insured by CHIP and CHIP Perinatal. This test card is available at no charge.

Process

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Lead Screening Helps Keep Your Baby Safe From Lead Poisoning

Very young children are curious! They love to explore. But lead poisoning from lead paint, chips and dust, and lead in water, can interfere with growth, harm hearing, lower IQ scores and cause behavioral problems. There are usually no signs or symptoms until a child is seriously ill with lead poisoning. To check for lead poisoning, have a simple blood test for lead at regular appointments around your child’s first and second birthdays.

You can get an early start protecting your baby from lead by:

• Using cold tap water, not hot, to make infant formula. Let the cold water run for at least a minute to remove any lead picked up from the pipes.
• Using iron-fortified infant formula and cereals for toddlers, to help lower your baby’s lead risk.
• Washing your baby’s hands, pacifier and toys often.
• Being sure your toddler doesn’t put paint chips or plaster in his or her mouth, or chew on windowsills or stair rails.
• Damp mopping floors to remove lead dust.
• Keeping your toddler out of the house during any home renovations.

How To Get Temporary Tenncare Right Now

If you are pregnant, you may be eligible to get temporary TennCare right now. This is called presumptive eligibility. This will cover your visits to the doctor and other medical services while you are pregnant.

You can enroll if your income is under the limit in the table below. You must live in Tennessee and you must be a U.S. citizen or eligible immigrant.

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What Other Documents Do Women Need To Send With Their Application

Women applying for CHIP perinatal services need to submit the following documents of proof:

Proof of Income

Proof must show current income for each person in the home. Proof can be:

• Pay check stub from the last 60 days showing pay before taxes or deductions
• Last years tax return
• Proof of self-employment
• Letter from your employer. This letter takes the place of a paycheck stub. It should how much you make now and how often you get paid. It also should include your name, the employers name, and the employers signature.
• Social Security statement

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In person

Finished applications and copies of required information can be turned in to a local HHS benefits office. To find the office nearest you, call 2-1-1 or 877-541-7905 after you pick a language, press 2.

If You Dont Have Health Coverage

• Health coverage makes it easier to get the medical check-ups and screening tests to help keep both you and your baby healthy during pregnancy.
• If you qualify for a Special Enrollment Period due to a life event like moving or losing other coverage, you may be able to enroll in a Marketplace health plan right now. Being pregnant doesnt make you eligible, but the birth of a child does.
• Create an account now to apply for Marketplace coverage through the Open Enrollment Period or a Special Enrollment Period. If you select the option to get help paying for coverage on your application, youll be asked if youre pregnant. Reporting your pregnancy may help you and your family members get the most affordable coverage.
• If you dont qualify for a Special Enrollment Period right now, youll be eligible to apply within 60 days of your childs birth. You can also enroll in 2021 coverage during the next Open Enrollment Period this fall.
• If eligible for Medicaid or CHIP, your coverage can begin at any time.

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Monitoring Substitution Of Coverage In Chip

States are required to include in their state plan a description of procedures used to ensure that CHIP coverage does not substitute for coverage under group health plans. States use various procedures to prevent substitution of coverage, such as monitoring survey data or private insurance databases, or applying a waiting period for individuals who are no longer enrolled in private coverage. This requirement can be found at section 2102 of the Social Security Act. Additional information on states specific CHIP waiting period policies.

Chip Does Not Cover Long

If you have a child with a disability and make too much money to get Medicaid, you might be able to get coverage through the Medicaid Buy-In for Children program. MBIC allows families of children with disabilities to make a monthly payment to get Medicaid coverage.

Learn about other programs and services for people with disabilities.

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Can I Request A Replacement Medicaid Card

The Medicaid card should be presented to medical providers when medical care is being requested. To request a replacement card, call 850-300-4323. Those on Medicaid can print a temporary Medicaid card from their MyACCESS Account. Further information on Medicaid services is available from the Agency for Health Care Administration.

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What If You Dont Have Health Insurance

If you dont have health insurance, now is the time to get it. Youll need coverage for the babys delivery and for frequent newborn checkups.

Medicaid and the Childrens Health Insurance Program

Medicaid and the Childrens Health Insurance Program 6 are insurance programs for low-income people, including pregnant women and children. Medicaid eligibility and program rules vary by state. Check with your state to see if you qualify for free or low-cost coverage. Some people on Medicaid pay a small portion of costs, while others pay nothing at all.

CHIP covers children whose families earn too much to qualify for Medicaid and, in some states, lower-income pregnant women.

Consolidated Omnibus Budget Reconciliation Act

If you or your spouse or partner recently lost their job at a company with at least 20 employees, youre likely eligible for coverage through the Consolidated Omnibus Budget Reconciliation Act .7

With COBRA, you can buy your former employers health insurance at full price for 18 months8 after youve left the job. COBRA tends to be very expensive because the employer no longer pays any part of your premiums. But if youre about to have a baby and you dont have other options, COBRA may help in the short term. Check with your former employer for details about costs and the process for getting covered.

Qualified Medical Child Support Orders

State Programs

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At The Social Security Office

If you did not apply for a Social Security number at the same time you filled out the information for the childs birth certificate, you can do so later at a Social Security office. In this case, you must:

• Complete an application for a Social Security card

• Show original documents proving your childs:

• U.S. Citizenship

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How Do I Apply For Medicaid

You can apply for Medicaid in any one of the following ways:

• Write, phone, or go to your .
• In New York City, contact the Human Resources Administration by calling 557-1399.
• Pregnant women and children can apply at many clinics, hospitals, and provider offices. Call your local department of social services to find out where you can apply.

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Will A Marketplace Health Plan Also Cover A Newborn

Yes. The ACAs EHB requirement mandates coverage of maternity and newborn care. Newborn care covers childbirth and immediate care for the baby after birth. The specifics of this coverage will vary by state and by each individual plan, but all women in Marketplace coverage must also enroll their baby in coverage soon after birth.

If the newborn is eligible for Marketplace coverage, then the parents can choose to add the baby to the familys existing Marketplace plan or choose a new Marketplace plan for the baby. If they opt for the latter, they can enroll the baby into a new Marketplace plan at any metal tier. However, when enrolling a newborn into Marketplace coverage, other members of the household are generally not permitted to change their existing Marketplace coverage.