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December 2016 Texas Medicaid Provider Procedures Manual

Section 4: Client Eligibility : 4.1 General Medicaid Eligibility : 4.1.5 Newborn Eligibility

4.1.5
A newborn child may be eligible for Medicaid for up to 1 year if:
If the newborn is eligible for Medicaid coverage, providers must not require a deposit for newborn care from the guardian. 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 (Form H1027) from HHSC a few weeks after the child’s birth. Form H1027 includes the child’s Medicaid identification number and effective date of coverage. After the child has been added to the HHSC eligibility file, a Your Texas Benefits Medicaid card is issued. Newborn clients will receive the Your Texas Benefits Medicaid card approximately two weeks after birth.
Providers can verify eligibility though the Medicaid eligibility verification website at www.YourTexasBenefitsCard.com. After the newborn becomes a Medicaid client, the card website shows that client as eligible, even if the card has not been produced yet.
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:

Texas Medicaid & Healthcare Partnership
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