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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).
   
   
   • 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.
     
     
   • 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.
     
     
   • If the baby's number is inactive, continue following these steps to activate the newborn's Medicaid identification number.
     
     
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. Complete an Unborn Activation Form [430 KB PDF] Photocopies of this form are acceptable.
   

Please be sure to fill out the form completely. For example, Mother’s Medicaid ID, Mother’s SSN, and Newborn’s Medicaid ID are required fields. Incomplete forms will be returned to you and will delay the process.

You may fax the form to Medicaid's fiscal agent, HP Enterprise Services, at 877-231-2170 to have the coverage activated or you may mail the completed form to:

HP Enterprise Services
Recipient Support Contact Center
P.O. Box 7090
Tallahassee, FL 32314-7090

Within two working days after receiving the completed form, 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 HMO, the baby will be retroactively enrolled in the same HMO 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 your local Medicaid area office.

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 Provider Inquiry Newborn Spreadsheet [59KB] to the appropriate DCF Customer Call Center. This spreadsheet can also be used to contact DCF to activate an unborn record, to request assistance regarding missing eligibility for newborns or issues concerning incorrect demographics such as discrepancies in dates of birth. Providers should send no more than one email submission, per day, to each DCF Customer Call Center Region based on the recipient’s region of residence.

There are three DCF Customer Call Centers serving six regions:

• Jacksonville Customer Call Center - includes the Northwest and Northeast Regions
• Tampa Customer Call Center - includes the Central and Suncoast Regions
• Miami Customer Call Center - includes the Southeast and Southern Regions

To locate the appropriate call center for the recipient’s region of residence, please access the following link at http://www.dcf.state.fl.us/regions/. Please review the Provider Inquiry Newborn Spreadsheet Completion Guide [48KB] for further instructions on completing and submitting inquiries to DCF.

Managed Health Care Providers

Information regarding newborn eligibility and unborn activation procedures specific to Medicaid managed health care plans can be found in Policy Transmittal 08-08 Unborn Activation Process and its attachments in the Medicaid Managed Health Care 2008 Policy Transmittal Archive.