Newborn Enrollment

Medicaid enrollment is automatically processed for newborns whose mothers are receiving Medicaid at the time of the baby’s birth.  This user guide describes the automated enrollment process.

The Newborn Enrollment process is completely automated.  The steps described below are part of a batch process that requires no worker intervention.

 

Process Steps

To process the automatic enrollment of a newborn in Medicaid:

1.      A newborn file from EOHHS that includes information about moms and their newborns is processed by RI UHIP.  During processing, the system looks for pregnant woman active in Medicaid.

 

2.      Each record on the file is processed. A match is identified when the first name, last name, date of birth and SSN for a pregnant woman on the file exactly matches information for a pregnant woman receiving Medicaid on InRhodes or RI UHIP.

 

3.      If no RI UHIP or InRhodes match is found for mom, her newborn is not enrolled.

 

4.      When a match is identified and mom is active on RI UHIP: 

·        The baby is added to mom’s current RI UHIP account. 

·        The baby is determined RIte care eligible from his or her date of birth. 

·        Mom’s pregnancy information on RI UHIP is updated to indicate she is no longer pregnant.  

·        A notice is created informing mom that the baby is approved for Medicaid.

 

5.      When a match is identified and mom is active in InRhodes:

·        A new RI UHIP account is created in Mom’s name.

·        Baby is added to mom’s RI UHIP account and receives Rite Care on this account. 

·        Baby is determined eligible from his or her date of birth.

·        A notice is created informing mom that the baby is approved for Medicaid.  It also indicates that an RI UHIP account has been created and provides a user name and temporary password for the account.

·        Mom remains active on InRhodes

If a potential match is found for the baby during MCI clearance, an MCI task is created ad must be resolved by an admin worker.  See the Create a New MCI Number and Associating an Existing MCI with an Account user guides for instructions on resolving an MCI task.

 

Results of the Procedure

 

The newborn is enrolled in Medicaid. If mom has an RI UHIP account, the baby is added to this account. If mom is active in InRhodes and does not have an RI UHIP account, an account is created for mom and the baby is added to this account.  Mom remains active on InRhodes.