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Medicaid Newborn Eligibility Policy

Medicaid Newborn Eligibility Policy

Unborn Activation Process

In October 1999, the Department of Children and Families and the Agency for Health Care Administration began issuing Medicaid identification numbers and gold cards to pregnant women for their unborn children. This step was taken in an effort to streamline and expedite the administrative process of adding a Medicaid eligible newborn's coverage to the Florida Medicaid Management Information System (FMMIS) upon the baby's birth so that providers could verify eligibility, bill Medicaid, and receive reimbursement for services rendered as quickly as possible.

Cards initially issued to unborn babies contain the mother's name with "Babyof" (e.g., BabyAofJane Smith) and providers are able to use the card with its card control number to obtain the baby's Medicaid ID number. The Medicaid number will not be active until after the baby is born, however. Once born, providers can activate the Medicaid coverage by following the instructions listed below:

  1. Using the card control number, look up the baby's eligibility record using the Web portal, MEVS, FaxBack, or AVRS (for further information on verifying eligibility, please see the Florida Medicaid Provider General Handbook, Chapter 3).
  2. Verify the mother was eligible for full Medicaid on the baby's date of birth by using the Web Portal, MEVS, FaxBack, or AVRS. The Medicaid fiscal agent will not activate the baby's coverage if the mother is not eligible or her eligibility category is MU (Presumptively Eligible Pregnant Woman) or her eligibility category is FP (Family Planning Services Only).
  3. Providers and Medicaid managed care plans should submit a newborn activation request through the Newborn Activation feature in the Florida Medicaid Secure Web Portal and Florida Health Plan Portal.  Additional instructions and a quick reference guide can be found on the Florida Medicaid Web Portal[ application/pdf ] .
  4. If the message tells you that the baby is eligible, no further action is required. Be sure to write down the baby's Medicaid identification number for billing purposes.
  5. NOTE : If the baby's ID is active but Medicaid eligibility is not on file for the dates of service or certain demographic information appears incorrect such as date of birth, the Unborn Activation process can NOT be used to make these corrections. Further updates/corrections must be coordinated with DCF.
  6. If the baby's number is inactive, continue following these steps to activate the newborn's Medicaid identification number.

Within two working days after after a completed submission through the portal, the Medicaid fiscal agent will update the newborn's name, gender, and birth date and activate the coverage. Once the newborn's name is updated on file, a new Medicaid gold card is issued with the updated name.

If the mother is in a Medicaid managed care plan, the baby will be retroactively enrolled in the same managed care plan as the mother for the first three months of life unless the mother voluntarily enrolls the baby in a different managed care plan.

If you have any questions regarding this process, please contact Recipient and Provider Assistance.

Provider Inquiry Newborn Spreadsheet

If you know the mother is pregnant, Medicaid eligible, and her unborn child does not have a number, you may have the baby added by emailing a password protected Master Unborn Provider Spreadsheet [ excel 18.4 kB ] to the statewide DCF email address identified on the spreadsheet. This spreadsheet can also be used to contact DCF to request assistance regarding missing eligibility for newborns or issues concerning incorrect demographics such as discrepancies in dates of birth.

Please review the Provider Unborn Update Spreadsheet Completion Guide [ pdf 34.2 kB ] for further instructions on completing and submitting inquiries to DCF.

Managed Care Plans

Information regarding newborn eligibility and unborn activation procedures specific to Medicaid managed care plans can be found in Attachment II, Exhibit II-A Managed Medical Assistance (MMA) Program, of the SMMC Contract found on the SMMC Plans page.

Medicaid