DPSS ePolicy

• Convert existing policy to the new webpage - No content changes
• To revise existing policy and/or form(s)

What changed?

1. System and procedural terminology has been updated.
2. Medi-Cal Mail-In District #89 is the departmental primary contact for MC 330 Newborn Referrals; and
3. Procedures for processing referrals have been revised.
4. An Important Information Notice Deemed Eligible Children was developed and released for use.  The notice provides Deemed Eligibility information to parents/caretakers of a child under age one.  The notice is available in English and Spanish.
5. A dedicated, toll-free telephone number was created for parents/caretakers to call if they are informed that a deemed infant is no longer eligible before age one.  The telephone number is assigned to Medi-Cal Mail-In District #89 and is included in the Important Information Notice Deemed Eligible Children.
6. The cure period for discontinued cases has changed from 30 days to 90 days.

Infants born to mothers who were eligible and receiving Medi-Cal benefits in the birth month are Deemed Eligible (DE) until age one, based on their mother’s eligibility.  The following conditions apply to a DE infant until age one:

• The DE infant’s beginning date of Medi-Cal eligibility is the infant’s date of birth, even on a CalWORKs (CW) case.
• Once the infant is DE in the birth month, the deemed eligibility continues until the end of the month the infant turns one year old.
• The DE infant remains eligible until age one regardless of the MC household’s continued eligibility.
• Infants born to mothers with restricted coverage are entitled to full scope benefits.  See Example 1 below.
  • Example 1:  The mother is eligible to restricted services with a Share of Cost (SOC) that is met in the birth month.  The infant is DE to full scope benefits with the same SOC amount.
• Changes in income and property that result in an increased SOC or ineligibility for the household are disregarded for the infant until age one.
• Infants who meet the deemed eligibility criteria must be evaluated even if the infant is not living with the mother at the time of application.  The infant and birth mother do not have to live together for the deemed eligibility to continue.
• Mothers who have a SOC for pregnancy related services must meet their SOC obligation in the infant’s birth month.  If the SOC is met, the infant is DE with a SOC.  See Example 2 below.  If the SOC is not met, the infant is not DE. 
  • Example 2:  If the mother has a SOC that was met in the birth month, the infant is DE with the same SOC.
• Infants born to a mother who is receiving CW in the birth month are DE.  The beginning date of aid for Medi-Cal is the infant’s birth month, regardless of the report date, CW pending eligibility or the beginning date of CW eligibility.  See Example 3 below.
  • Example 3:  A pregnant woman has been receiving CW for herself and two children since June 1, 2017.  On 11/07/17, she reports that her child was born on 10/29/17.  The mother is given a list of documents needed to establish CW eligibility for the child.  The CW beginning date of aid will be established following CW rules.  However, the child is DE for Medi-Cal as of 10/29/17, even if the CW verification is not provided and CW is discontinued.
• The infant must continue to reside in California.
• Deemed eligibility is established without an application if the child can be linked to the mother’s case and/or MEDS record.

Title 22, California Code of Regulations (22 CCR) Section 50262.3 Continued Eligibility (CE) Program for Pregnant/Postpartum Women and Infants, established that infants born to Medi-Cal eligible mothers are automatically “deemed eligible” for Medi-Cal coverage, regardless of the mother’s scope of benefits, until age one.  For infants who meet the criteria, Medi-Cal regulations allow full scope medical services to be billed to the mother’s Benefit Issuance Card (BIC) for the birth month and the subsequent month to ensure continuous medical coverage.

Furthermore, Section 50189 of Title 22 CCR mandated Continuous Eligibility for Children (CEC) be implemented for children under age 19.  Changes that occur during the period following the last renewal which would cause ineligibility are disregarded until the next annual renewal or the end of the month that the child turns 19, whichever comes first.

SB X1 26 (Chapter 9, Statutes of 2003), states the goal of the Department of Health Care Services (DHCS) is to establish best practice guidelines for enrolling newborns into a Medi-Cal program within 10 days of receiving notification of the infant’s birth.

N/A

Action is required on all Newborn Referrals, regardless of the mother’s current eligibility status.  Deemed eligibility must be evaluated when a mother reports her newborn and was receiving Medi-Cal in the infant’s birth month under one of the following programs: Medi-Cal Assistance Only (MAO), CalWORKs (CW), Supplemental Security Income (SSI), Breast and Cervical Cancer Treatment Program (BCCTP), Medi-Cal Inmate Eligibility Program (MCIEP), Foster Care, or Former Foster Youth (FFY).  Although the conditions for CW eligibility may differ, an infant born to a CW mother that received MC pregnancy services in the birth month is DE and must be issued Medi-Cal benefits under this policy.

N/A