If a baby is born to a mother who was approved for PLN/PW coverage, but then is incarcerated in the middle of her CE period, and the child is born while the mother is still incarcerated, that child is a deemed newborn. Per KFMAM 2052.07 incarceration disallows Medicaid payment of medical claims, it does not impact a person’s eligibility. This person will maintain eligibility for Medicaid while residing in a correctional facility and upon release may have benefits reinstated without a new application as long as they continue to meet categorical program requirements (age, residency, etc.).
For this Deemed Newborn coverage to be approved, an override is needed. Follow the steps below to approve the PLN/DN coverage for the child.
From the Medical EDBC Summary page, click the Override Program Configuration button.
On the Program Configuration page, update the following fields:
EDBC Override Reason: Administrative Decision
Program status: Active
Update Reporting Type: Semi-Annual Reporting
Only required when overriding a Full Closure/Discontinuance, simply overriding 1 person, does not require this to be selected.
Click the Override button next to consumer(s) who need the information updated.
On the Program Configuration Override Detail page in the User Override section update the following fields:
Role: Mem
Status: Active
QHP Screened: No
Claiming Code: Federal
Status: leave blank
Role Reason: leave blank
Adult Child Code: leave blank
Click Save and Return button.
On the Program Configuration Override List page, click the Save and Return Button.
On the Medical EDBC Summary page, click the Override Medical Summary button at the bottom of the page.
The Medical EDBC Override List page displays.
From the Medicaid EDBC Override List page click the Override button next to the Deemed Newborns name.
From the Medicaid EDBC Override Detail page, in the User Override section complete the following fields:
Test Category: Poverty Level Programs
Test Result: Pass
Premium: if applicable
State Date: First day of the month EDBC is being ran for
End Date: Last day of the month EDBC is being ran for
CHIP start Date: if applicable – date EDBC is being ran
Premium Start Date: if applicable
In the Individual Budget Unit (IBU) section ensure the following fields are filled out for the child:
Person: Childs Name
Role: Mem
Aid Code: Poverty Level Programs – Deemed Newborns
Note: Be sure this section includes all people that will be part of the individual’s IBU:
Person: Name of individual
Role: FRI
Role Reason: Tax Dependent (for all other children that should be considered in the IBU), Primary Tax Payer (PA), or Spouse (SP)
Aid Code: leave blank
Click the Add button
Click the Save and Return button to go back to the Medicaid EDBC Override List page.
From the EDBC Override Reason drop down select Administrative Decision.
Check the box next to the bold overridden budget for the child. Click Save and Return.
The Medical EDBC Override List page displays again. Check the box next to the budget and click Save and Return.
The Continuous Eligibility Override Detail page displays.
Enter the CE End Month using the <MM/YYYY> format or the calendar icon. The CE End Month should create a 13-month Deemed Newborn CE Period. Example: Run month is 04/2024 and child was born 04/10/2024, CE End Month is 04/25.
Select the Adjustment Reason: New Policy/Regulation Change
Click Save and Return.
The EDBC Medical Summary page now displays showing the newly created budget for our consumer. Click the Accept button.
The EDBC List page displays. Click the Save and Continue button.
Create a Journal.
Create a manual approval for the DN.