22. Continued Eligibility for Pregnant Women, Infants, and Children [ ]

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1 Medi-Cal Handbook page Continued Eligibility for Pregnant Women, Infants, and Children [ ] The following Medi-Cal Continued Eligibility programs are established: Effective January 1, 1991, the federal Omnibus Budget Reconciliation Act (OBRA) of 1990, provides Continued Eligibility (CE) for pregnant women and infants up to age one when their is a change in family income. Assembly Bill (AB) 99 established the CE program effective October 1, Effective January 1, 2001, Assembly Bill (AB) 2900 (Chapter 945, Statutes of 2000), mandates a new Medi-Cal provision for Continuous Eligibility for Children (CEC) under age 19. CEC ensures that all children under age 19 who are determined eligible for zero share-of-cost Medi-Cal will maintain eligibility until the next redetermination or until the child turns 19, whichever occurs first. Effective October, 2003, the Continued Eligibility (CE) provision for infants under age one was changed to Deemed Eligibility (DE) to emphasize the distinction between Continuous Eligibility for Children (CEC). Effective February 4, 2009, the Children s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) reauthorized funding for the State Children s Health Insurance Program (CHIP), expanded coverage to children and changed DE requirements for infants Overview - Continued Eligibility for Pregnant Women and Infants Effective January 1, 1991, the federal Omnibus Budget Reconciliation Act (OBRA) of 1990, provides continued eligibility for pregnant women and infants up to age one when there has been a change in family circumstances. Under this program: Once a pregnant woman has been approved for Medi-Cal, increases in the share of cost due to increased income are not counted in her share of cost determination for pregnancy-related services, throughout the pregnancy, until the end of her 60-day postpartum period. Changes in MFBU or Maintenance Need Levels may affect the share of cost. Update # Revised:

2 page 22-2 Medi-Cal Handbook An infant whose mother is eligible for and receiving Medi-Cal in the month of delivery is automatically deemed eligible for one year without a separate application or SSN. Increases in the family's share of cost due to increased income or other changes in the MFBU are not counted in the newborn's share of cost determination until the child reaches age one. Pregnant women and infants must continue to meet other eligibility criteria, such as residency requirements. Increases in family income must be applied to all other persons in the MFBU and to a pregnant woman's non-pregnancy related services. Decreases in family income will continue to be applied to everyone in the MFBU, including pregnant women and/or infants under age one. However, any subsequent increases in income will be disregarded for the pregnant woman and infant under age one Affected Persons All Medi-Cal eligible pregnant women and infants (up to one year old) are potentially eligible for Continued Eligibility (CE)/Deemed Eligibility (DE), including those who are: Medically Needy (MN) or Medically Indigent (MI) and, due to an increase in family income or other changes in the MFBU, would change from no share of cost (SOC) to a SOC; or, would have a higher share of cost. Eligible under the Income Disregard and Property Waiver Programs with no SOC, and, due to an increase in income, would become ineligible for those programs. Minors who are receiving pregnancy related services under the Minor Consent Program. Public Assistance (PA) or Other PA recipients and, due to an increase in income, lose PA/Other PA eligibility and their no SOC Medi-Cal benefits. PA refers to cash benefits, such as CalWORKs or SSI/SSP. Other PA refers to cash-based Medi-Cal benefits, such as TMC (Aid Codes 39 and 59) and Edwards (Aid Code 38). Revised: Update # 15-08

3 Medi-Cal Handbook page Eligibility, General Continued Eligibility is intended to provide Medi-Cal, without increasing the share of cost, for the mother's pregnancy-related services and for the infant's medical care for the first year regardless of any increases in family income. EWs are to process a case that includes a pregnant woman or infant under age one as follows: Step Action 1. Apply regular Medi-Cal eligibility procedures for MN or MI. 2. Apply Sneede budgets, if applicable. 3. Review for eligibility under the Income Disregard/Property Waiver program, if there is a share of cost. 4. Review for Deemed Eligibility. 5. Apply Hunt v Kizer (old, unpaid medical expenses) to the SOC, if applicable. *Exception: An unmarried father is not required to be in the MN/MI MFBU until the month following the month that the child turns age one, unless he is requesting Medi-Cal for himself and/or any of his other mutual or separate children. (NOTE: This does NOT apply to Section 1931(b) Medi-Cal.) [Refer to Unmarried Fathers - MN/MI Medi-Cal, page 22-7 for more information.] CE only disregards increases in income, not decreases in the MFBU composition or maintenance need level that result in a SOC Eligibility for Pregnant Women Only a pregnant woman who is eligible for and receiving Medi-Cal in the month of birth is eligible for Continued Eligibility (CE). She must have met her share of cost (been certified) at least ONCE during her pregnancy, prior to, or in the same month as, the income increase, in order for her to qualify for Continued Eligibility (unless she is eligible under the Income Disregard Program). Continued Eligibility does NOT apply to any woman who receives Retroactive Medi-Cal coverage for the month of delivery. Update # Revised:

4 page 22-4 Medi-Cal Handbook Increases in the income or the property of the unmarried father do NOT affect the pregnant woman, regardless of whether he wants Medi-Cal for himself or other children. Increases in her husband's income do not affect her SOC, however changes in his property do affect her eligibility, unless she is eligible for the Property Waiver Program Adding Newborns, General Procedures to establish eligibility for the newborn are as follows: Step Action 1. Advise the mother to contact the EW once the child is born, as the baby's name, sex, date of birth, and residence must be known in order to establish eligibility. 2. If the birth has not been reported by the end of the expected birth month, contact the mother by the end of the following month. 3. Document at least two attempted contacts and follow SB 87 procedures before end-dating the pregnancy (or discontinuing the case if no one remains eligible). 4. Issue the baby's own BIC card effective the month of birth, even though the mother's card will cover services during the month of birth and the following month. 5. Have the mother obtain the baby's SSN and Birth Certificate as soon as possible, even though under CE rules it is not required until the child is one year old. If the mother provides the SSN prior to one year of age, the infant s real SSN must be reported to MEDS and used. This enables the child, at age one, to continue Medi-Cal eligibility without delay. A DE infant cannot be discontinued for not having an SSN of file until age one. REMINDER: Regular SSN requirements apply if the mother is not Medi-Cal eligible in the month of birth Newborn Referral Form (MC 330) Background Historically, EWs have relied on parents or family members to report the birth of a child. To compensate for any initial delay in establishing the infant s eligibility, Medi-Cal regulations allow services for a newborn to be billed on the mother s Medi-Cal card for the month of birth and the following month. Timely issuance of a Medi-Cal card for the infant still requires timely reporting of the birth. Revised: Update # 15-08

5 Medi-Cal Handbook page 22-5 The Newborn Referral Form (MC 330) was developed by the state Department of Health Care Services (DHCS) to facilitate the enrollment of DE newborns into Medi-Cal. Newborn Referral Procedure-Provider A supply of newborn referral forms is available to Medi-Cal providers who serve Medi-Cal eligible pregnant women, including hospitals, clinics, urgent care centers, independent nurse-midwives, and others. When a child is born to a Medi-Cal mother, the provider will: Obtain the written consent of the infant s parent or guardian, Complete the MC 330 with the mother s address, SSN and information on the newborn and forward the referral by mail or fax to the Benefits Service Center (BSC) for processing. The form may also be submitted or faxed to any district office by the client. Newborn Referral Procedure Each MC 330 received must cleared in CalWIN/MEDS and processed as follows: If the Mother... Is active in another county, Is active on Medi-Cal in Santa Clara County, Then the Referral Will Be... Forwarded to the county of record by designated staff. Forwarded to the appropriate District Office for assignment. Use the information from the referral form to activate the infant on the mother s Medi-Cal case. Contact the parent if the infant was never reported as an unborn. Is receiving SSI/SSP, BCCTP, or MCEIP Medi-Cal benefits at the time of birth, Processed as an application if no other family members are receiving Medi-Cal. Establish a case for the infant under the 200% Income Disregard/Property Waiver program using the infant s name, date of birth and gender and information available on MEDS for the mother. Update # Revised:

6 page 22-6 Medi-Cal Handbook If the Mother... Has no active case record, Then the Referral Will Be... Held for 30 days, then file-cleared again in CalWIN/MEDS. If the case is found to be active or pending at that time, the referral will be forwarded to the appropriate office for task assignment. If no case is found to be active at that time, a Medi-Cal Notice of Newborn Referral (SC 1374) must be completed and sent to the parent by the designated staff. If the child has an active Accelerated Enrollment (AE) or CHDP Gateway MEDS record, the referral will be forwarded to AAC for processing. REMINDER: Staff must enter the date of application recorded on the MEDS INQP screen. The MC 330 must be scanned into IDM under F1-Applications. Medi-Cal Notice of Newborn Referral Form (SCD 1374) The Medi-Cal Notice of Newborn Referral (SCD 1374) must be completed and sent to the parent/caretaker relative by designated clerical staff when no active record is found after 30 days. As part of our county s Medi-Cal outreach effort, the notice explains to the new mother that she may apply for Medi-Cal if she wishes. The SCD 1374 informs the parent that the county has no Medi-Cal case record and he/she must contact the Social Services Agency to apply for Medi-Cal. The MC 330 Newborn Referral form is NOT an Application for Medi-Cal. Therefore no Mail-In application packet is to be sent with the SCD Reminder: Infants born to mothers receiving SSI/SSP, BCCTP or MCIEP at the time of birth are also deemed eligible. The Medi-Cal case must be established by using the information available on the MC 330 and the mother s MEDS record. Revised: Update # 15-08

7 Medi-Cal Handbook page Unmarried Fathers - MN/MI Medi-Cal This section does NOT apply to Section 1931(b) Medi-Cal. [Refer to Pregnant Woman, page for information about unmarried fathers of unborns in the Section 1931(b) program.] MFBU An unmarried father living in the home is not required to be in the MN/MI MFBU until the month following the month that his child turns age one, unless he is requesting Medi-Cal for himself and/or any of his separate or mutual children. The unmarried father must be added to the MFBU the first of the month after the infant turns one year old. Income/Property Increases in the income or property of an unmarried father DO NOT affect the infant until the child reaches age one, regardless of whether the unmarried father wants Medi-Cal for himself or other children. [Refer to Sneede, page 22-8.] EWs are not required to verify the income or resources of an unmarried father (who does not want Medi-Cal for himself or other children) until the infant turns age one. U-Parent Linkage If an unmarried pregnant woman or the unmarried father in the home is unemployed, it is important that EWs explore and explain the benefits of establishing AFDC-MN eligibility based on unemployment. If there is linkage: The mother's eligibility can be continued after the 60-day postpartum period. The unmarried father may be eligible. EWs shall determine AFDC-MN (Aid Codes 34 or 37) linkage for the unmarried pregnant woman whenever possible. If... AFDC-MN linkage for the pregnant woman is dependent on the cooperation of the unmarried father in the home. Then the EW shall... Document in [Maintain Case Comments] whether or not he wishes to cooperate in establishing linkage for the pregnant woman. Update # Revised:

8 page 22-8 Medi-Cal Handbook If... The unmarried father is willing to provide employment information, have him complete an MC 210 S-W The unmarried father does not cooperate in providing information, and AFDC-MN linkage for the pregnant woman cannot be established otherwise. Then the EW shall... Establish eligibility for the pregnant woman under AFDC-MN (Aid Codes 34 or 37) if U-Parent deprivation exists. Establish eligibility for the pregnant woman under the MI program (Aid Codes 86 or 87). Information Provided Although an unmarried father is not required to be in the MN/MI MFBU until the newborn reaches age one, occasionally he may provide all necessary information and verifications. When this occurs: He may be included in the MFBU. If adding him adversely affects the mother or child (results in excess property or a share of cost) then Sneede rules apply. It is easier for EWs to allow him to opt out of the MFBU at application if he chooses to do so. However, it is not an error to include him if Sneede procedures are followed, because the end results will be the same. (NOTE: The unmarried father of an unborn must always be included in the MFBU for Section 1931(b) Sneede In cases where there is an unmarried father in the home and the MFBU has a share of cost or excess property, the following rules apply when determining eligibility for the newborn: After the baby is born, the child's eligibility is tied to the mother. If the unmarried father wants Medi-Cal for himself or for his other mutual children and there is a SOC or excess property, Sneede rules apply. [Refer to Court Orders: Sneede v Kizer, page 70-1.] Include the newborn under age one in the Responsible Relative determination, even though the newborn will not actually receive an allocation from the unmarried father until the month after the child turns age one. There is to be NO ALLOCATION FROM THE UNMARRIED FATHER TO THE INFANT during Continued Eligibility. Revised: Update # 15-08

9 Medi-Cal Handbook page 22-9 Mother's income, before any increases, is allocated to the baby. If a pregnant woman/infant are included in an MBU that has a SOC, evaluate them under the poverty level programs. If a SOC remains and they had no SOC or a lower SOC in the prior month, apply Continued Eligibility rules Medical Support Enforcement For purposes of medical support enforcement, an absent parent still has a legal responsibility for the health and welfare of his child(ren). A medical support referral must be made at the end of the mother s 60-day postpartum period if there is an absent parent Three Month Retroactive Use actual income to determine the share of cost for each retroactive month requested. Once an increase in income is reported subsequent to the month of application, the increase is to be disregarded. Increases in income after the month of application trigger Continued Eligibility, not the family's income in the retroactive months or the date of the initial interview. Example 1: A woman applies for Medi-Cal on 10/30/11. She had a baby 10/5/11. She requests Retro Medi-Cal for August and September. She completes the application process on 11/15/11. Her net nonexempt income is as follows: (Retro) (Retro) (App. Mo.) (Current Mo.) 8/11 9/11 10/11 11/11 None $1,000 $1,200 $1,800 Actual income is budgeted for August and September. In November, her income is much higher. Since she applied during the month of October, the income increase in November is disregarded under Continued Eligibility rules. Even though she applied after the baby was born, October is not a Retro month; therefore, CE rules apply. Once her SOC for 10/11 is certified, she receives zero SOC postpartum services for November and December. The newborn's SOC is based on October's income until the child turns age one, unless income decreases. Update # Revised:

10 page Medi-Cal Handbook An infant can receive DE retroactively when one of the three months prior to the application month is the infant s birth month and the mother, parent, legal guardian or responsible relative of the infant requests Medi-Cal coverage for that month. If the infant s mother had Medi-Cal eligibility in the birth month, then apply DE to the infant beginning in that retroactive month. Example 1: A mother applies for Medi-Cal on July 6, 2011 for herself and her infant. The infant s date of birth was June 16, The mother indicates on her application that she has unpaid medical bills for May and June and requests Medi-Cal for May and June. The EW approves Medi-Cal for July 2011 and ongoing. In determining her retroactive Medi-Cal eligibility, the EW determined that she was not eligible in May but eligible for June. Because the infant s month of birth is in the retro month of June and the mother was Medi-Cal eligible in June, the infant has DE beginning in June Break In Aid Once a pregnant woman and/or infant are no longer eligible for Medi-Cal, Continued Eligibility ends. Any break in aid causes Continued Eligibility to end. For example, a family moves from County A and fails to notify their EW, so the case is discontinued 10/31. The family reapplies in County B after the 30 day timeframe allowed by SB 87. This is considered a break in aid for purposes of determining Continuing Eligibility. County B determines eligibility and SOC based on November's income Intercounty Transfers (ICTs) If an ICT is received, the client is entitled to CE, per the requirements set forth in this section, as no break in aid occurs. When initiating an ICT for a beneficiary who is entitled to CE, EWs must include adequate documentation/explanation for the Receiving county Whereabouts Unknown If the mother s and infant s whereabouts become unknown, the case may be discontinued with a timely notice of action after following SB 87 procedures for loss of contact. However, if the family reestablishes contact, and the infant remained in California continuously since the discontinuance, the following applies: Revised: Update # 15-08

11 Medi-Cal Handbook page The infant s eligibility must be restored back to the date of discontinuance and through the current month. Even if the infant reached age one or ceased to reside with the mother at some point during the period of discontinuance, the infant s eligibility is uninterrupted because no timely NOA was given. If CE requirements were met in every month of the discontinuance period, the EW must determine whether the requirements are expected to be met in the future month. If so, CE continues. If the EW determines that the infant did not meet the requirements in any of these prior months, the EW must determine whether the infant has Medi-Cal eligibility on any other basis. If no other basis for eligibility exists, the infant can be discontinued with a timely notice of action Annual Redeterminations The following requirements apply when an MFBU includes a pregnant woman and/or a child under age one: Redeterminations must be completed annually as a condition of eligibility for pregnant women. The infant is given the same annual redetermination as the rest of the family and will have his/her annual RD completed along with the family s, even if the family s annual redetermination date is before the infant s first birthday. Deemed eligibility continues until age one regardless of any adverse actions that may apply to the rest of the family. Failure of the mother to complete the annual RD only affects the mother s eligibility and does not affect the infant s deemed eligibility. Regular Medi-Cal requirements apply for the mother and other family members if the client fails to complete the annual RD or provide all necessary information or verifications to complete the RD. Important: For AFDC/MN-MI Medi-Cal, do not request verification of the income or resources of the unmarried father in the home prior to his child's first birthday, unless he and/or his other mutual or separate children are receiving Medi-Cal. If it is determined at RD (or any other time) that the mother has excess property, the mother would be ineligible, and the baby would no longer be deemed eligible (unless eligible under the Property Waiver Program). Update # Revised:

12 page Medi-Cal Handbook Increased Income, Pregnant Woman (MN/MI Programs) Use this chart to determine under which program a pregnant woman's eligibility continues when there is an increase in family income or SOC: If the Prior Month Aid is... No SOC, MN/MI or PA/Other PA Income Disregard Program (between Maintenance Need and 200% of FPL) Property Waiver Provision SOC, MN/MI (Income over 200%) And Income Increases... But does not exceed Maintenance Need Between Maintenance Need and 200% of FPL Over 200% At or Below 200% Over 200% At or Below 200% Over 200% Still Over 200% Then Continue Eligibility for the Pregnant Woman under... MN/MI, no SOC. (Unaffected by Continued Eligibility) Income Disregard Program for pregnancy related services. Increase her SOC for nonpregnancy care. Income Disregard Program for pregnancy related services. Increase her SOC for nonpregnancy care. Income Disregard Program for pregnancy related services. Increase her SOC for nonpregnancy care. Income Disregard Program for pregnancy related services. Increase her SOC for nonpregnancy care. Property Waiver Provision for pregnancy related services. Property Waiver Provision for pregnancy related services. (Use Income Disregard Program Aid Code.) Continue pregnant woman at prior month's SOC for both her pregnancy and nonpregnancy services. Decreases in family income are still considered. Revised: Update # 15-08

13 Medi-Cal Handbook page Increased Income, Infants (MN/MI Programs) Use this chart to determine under which program an infant's eligibility continues through the month that the child turns age one, when there is an increase in family income or SOC: If the Prior Month Aid is... No SOC, MN/MI or PA/Other PA Income Disregard Program (between Maintenance Need and 200% FPL) Property Waiver Provision SOC, MN/MI (Income over 200%) And Income Increases... But does not exceed Maintenance Need Between Maintenance Need and 200% of FPL Over 200% At or Below 200% Over 200% At or Below 200% Over 200% Still Over 200% Then Continue Eligibility for the Infant under... MN/MI, no SOC. (Unaffected by Continued Eligibility) Income Disregard Program. No SOC. Income Disregard Program. No SOC. Income Disregard Program. No SOC. Income Disregard Program. No SOC. Property Waiver Provision. No SOC. Property Waiver Provision. No SOC. (Use Income Disregard Program Aid Code.) Continue infant at prior month's SOC. The SOC for other MFBU members is increased, except for a pregnant woman's pregnancy related services. Decreases in family income are still considered Increased Income, PA/Other PA Recipients/Section 1931(b) Pregnant women and infants who are discontinued from CalWORKs, Section 1931(b), Transitional Medi-Cal (TMC), or Edwards are potentially eligible for Continued Eligibility. Update # Revised:

14 page Medi-Cal Handbook Determine eligibility for no share of cost (SOC) Medi-Cal in the following sequence: Step Action 1. When a pregnant woman and/or infant under age one is discontinued from CalWORKs, first determine eligibility under the Section 1931(b) program. NOTE: Edwards Medi-Cal is appropriate if there is NOT enough information in the case record to determine ongoing Medi-Cal eligibility. Once there is a break-in-aid, Continued Eligibility ends. 2. If ineligible for Section 1931(b), determine eligibility for no SOC under Transitional Medi-Cal (TMC). 3. If ineligible for TMC, determine ongoing Medi-Cal eligibility under the MN/MI programs. Disregard increases in family income for the pregnancy related services and for the infant's SOC determination. If Income is: At or below Maintenance Need Level Above Maintenance Need Level (regardless of how high the income is) Then Establish Medi-Cal under: MN/MI Program, No SOC, unaffected by Continued Eligibility. Income Disregard Program for: Pregnancy related services, and A child under age one. Apply full SOC to: Other family members, and The pregnant woman's nonpregnancy care. NOTE: Other children in the MFBU may be eligible for No SOC under Federal Poverty Level programs Determining MFBUs/SOC The following examples describe situations when family income increases: Example 1 A family of 4 includes Mom (pregnant), Dad, and their 4 year old child. At application the family income is between Maintenance Need and 200% of FPL. Dad is ineligible, as he is fully employed. (All family members are citizens.) Revised: Update # 15-08

15 Medi-Cal Handbook page Three months later, the family reports income over 200% of FPL. The increased SOC is applied to all MI family members the first of the following month. Mom stays active under the Income Disregard Program with the same Aid Code until the end of the 60 day postpartum period, without regard to any increases in income. The newborn will later be activated under the Income Disregard Program. Increases in family income will not affect the newborn until age one, as long as other eligibility criteria are met. Example 2 A family of 3 (Mom, Dad and their unborn) is currently eligible for Section 1931(b) Medi-Cal. Dad is an unemployed PWE. In January the infant is born and is added to the Section 1931(b) MFBU. In March, Mom returns to work and the family becomes ineligible for Section 1931(b) due to her earnings. Section 1931(b) is discontinued and the first 6 months of TMC is approved (April thru September). The family does not qualify for the second 6 months of TMC because their income is too high. The EW approves AFDC-MN with a SOC. Since the child is not yet one year old, DE applies. He/She is not affected by any increase in family income. Therefore, the child is issued zero SOC Medi-Cal under the 200% FPL program. Example 3 An unmarried pregnant woman lives alone and has net nonexempt income of $1000 per month; therefore, she is eligible for the 200% Income Disregard Program with no SOC for her pregnancy related services. During her pregnancy, her income increases to $1500. Continued Eligibility Rules: Her SOC is increased only for non-pregnancy care, Aid Code 37. She continues on the Income Disregard Program for her pregnancy care until the end of the 60 day postpartum period, Aid Code 44 (citizen). At the end of the 60 day postpartum period, she is discontinued from the Income Disregard Program and her full scope Medi-Cal continues with a SOC. The newborn continues to be eligible under the Income Disregard Program, with no SOC, through the month the child attains age one, provided all other DE eligibility factors are met. Update # Revised:

16 page Medi-Cal Handbook Example 4 A family of 4 includes Mom (pregnant), Dad, and their 3 year old child. In October Dad is fully employed and net nonexempt income is over 200% of FPL, so they have a share of cost of $1150. In December they report increased earned income, and the new SOC is $1450. Mom's SOC is frozen at the lower SOC. The pregnant woman continues under the lower SOC amount for both her pregnancy and non pregnancy related services. MEDS does not allow an individual to have two different SOC amounts with the same Aid Code simultaneously in the same month. Change in MFBU Size Continued Eligibility rules apply when changes in the size of the MFBU and/or in the Maintenance Need Level cause an increase in the SOC. For example, a family member moves out of the house, but the household's income remains the same. The SOC increases due to the new, lower Maintenance Need Level. The SOC increase is NOT applied to the pregnant woman and/or infant Deemed Eligibility for Infants Overview Infants born to women who are eligible for and receiving Medi-Cal on the date of the infant s birth are automatically deemed eligible for Medi-Cal for one year: Without a separate Medi-Cal application, and Without requiring a Social Security Number (SSN) for the infant, and Without considering the infant s living arrangements or the mother s eligibility status. A new application (SAWS 1) is required when the child turns age one only in those cases when the mother is ineligible and no one else in the family is receiving Medi-Cal. A new MC 210 or MC 321 HFP is not required if there is one on file which was completed within the last 12 months. Revised: Update # 15-08

17 Medi-Cal Handbook page Program Eligibility Under DE, the infant s eligibility in the birth month is based on the mother s no SOC or SOC eligibility on the date of the infant s birth, except that an infant covered under the mother s Medi-Cal BIC receives full-scope benefits even if the mother only has restricted benefits. If the mother was in the Medically Needy/Medically Indigent (MN/MI) program with a SOC that she met in the month of the infant s birth, the infant is in the MN/MI program with a SOC. If the mother is in the Income Disregard program, the infant is also in the Income Disregard program. If the mother is receiving Medi-Cal under the Supplemental Security Income/State Supplementary Payment (SSI/SSP) program, the Federal Breast and Cervical Cancer Treatment Program (BCCTP), or the Medi-Cal Inmate Eligibility Program (MCIEP) and the mother has Medi-Cal eligibility in the month of the infant s birth, the infant has DE for Medi-Cal without a separate application and is eligible for no SOC Medi-Cal. Notification may come from the parent, legal guardian, responsible relative or authorized representative, or the Newborn Referral Form (MC 330) from the hospital. Since the infant cannot be placed into the mother s Aid Code, he/she must have eligibility established under the Income Disregard/Property Waiver program. A new Medi-Cal case will need to be established if there is no previous case history. The annual RD is due when the infant turns age one. If there are other family members on Medi-Cal, or the infant s father is now requesting Medi-Cal, the infant is included in the same MFBU for regular Medi-Cal eligibility. [Refer to 22- for procedures to establish Medi-Cal eligibility for this deemed infant.] Residency California residency is a federal requirement to receive Medi-Cal. As long as the infant resides in California, the infant meets the residency requirement for DE. DE does not continue when an infant moves from the state of birth where he/she initially received DE to another state. When a DE infant moves to another state, the DE terminates. Likewise, when an infant with DE arrives from another state, he/she is not DE eligible because the infant s mother was not eligible for and receiving Medi-Cal in California on the date of birth. Update # Revised:

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