TMPPM 2008 > Texas Medicaid Services > Texas Health Steps (THSteps) > THSteps Medical and Dental Administrative Information

43.1.5.1 Newborn Eligibility

A newborn child may be eligible for Medicaid for up to one year if the child's mother is:

•Receiving Medicaid at the time of the child's birth.

•Eligible for Medicaid or would be eligible if pregnant.

•Living with the child.

If the newborn has Medicaid coverage, providers may not require a deposit for newborn care from the guardian. The child's eligibility ends if the child's mother relinquishes her parental rights or if it is determined that the child is no longer part of the mother's household. The hospital or birthing center must report the birth to HHSC Eligibility Services at the time of the child's birth.

If the hospital or birthing center notifies HHSC Eligibility Services that a newborn child was born to a Medicaid-eligible mother, then the hospital caseworker, mother, and attending physician (if identified) should receive a Medicaid Eligibility Verification Letter (Form H1027) from HHSC a few weeks after the child's birth. The H1027 includes the child's Medicaid number and effective date of coverage. After the child has been added to the HHSC eligibility file, a Form H3087 is issued.

Note: Claims submitted for services provided to a newborn eligible for Medicaid must be filed using the newborn client's Medicaid number. Claims filed with the mother's Medicaid number cause a delay in reimbursement.

The Medicaid number on the Medicaid Eligibility Verification (Form H1027) may be used to identify newborns eligible for Medicaid.

Refer to: "Medicaid Identification Form H3087" .