Practice Support Update Blog

Medicaid Managed Care: Eligibility for Newborns

Mar 30, 2021 2:06:24 PM / by Practice Support Team

On March 18, 2021 NC Department of Health and Human Services posted a factsheet in the Provider Playbook entitled Managed Care Eligibility for Newborns: What Providers Need to Know. Read important highlights below: 

Eligibility Requirements for Newborns 

A child born to a woman with health coverage through Medicaid on the date of the child’s birthhighrisknewborn is automatically eligible for Medicaid. The newborn is “deemed eligible” based on the mother’s Medicaid coverage. The child’s Medicaid eligibility certification period is from the first day of the month of birth through the end of the month the child turns one year of age.  

A child whose mother is not covered by Medicaid for the birth of the child may be eligible for Medicaid. An application must be submitted for the child and the child must meet all eligibility requirements, including income. The local county department of social services (DSS) determines eligibility the same as for any Medicaid applicant.  


Newborn Plan Assignment 



To learn more or find answers to your most common questions check out this factsheet Managed Care Eligibility for Newborns: What Providers Need to Know.


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Tags: Medicaid Managed Care, NCDHHS, Pediatric

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