Medicaid Newborn Eligibility Policy
As of October 1, 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.
Providers will be able to inquire about the unborn baby's eligibility with the card control number; however, the Medicaid number will not be active until after the baby is born. Providers will be able to activate the coverage by following the instructions listed below:
- Look up the baby's eligibility record on MEVS, FaxBack, or AVRS.
- If the message tells you that the baby is eligible, no further action is required. Be sure to write the baby's Medicaid identification number down for billing purposes.
- If the baby's number is inactive, continue following these steps to activate the newborn's Medicaid identification number.
- Verify the mother was eligible for Medicaid on the baby's date of birth by using 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).
- Complete an Unborn Activation Form. [430 KB PDF]
- Unborn Activation Process
- Letter to Health Plans [97KB]
- Attachment 1 [127KB PDF]
- Attachment 1 - A [99KB PDF]
- Attachment 1 - B [99KB PDF]
- Attachment 2 [521KB PDF]
- Attachment 3 [518KB PDF]
Please be sure to fill out the form completely. Incomplete forms will be returned to you and will delay the process.
You may fax the form to Medicaid's fiscal agent, EDS, at 877-231-2170 to have the coverage activated or you may mail the completed form to:
EDS
Recipient Support Contact Center
P.O. Box 7090
Tallahassee, FL 32314-7090
You may make photocopies of this form.
Within two working days after receiving the completed form, the Medicaid fiscal agent will add the newborn's name and birth date and activate the coverage.
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 know the mother is pregnant, Medicaid eligible and her unborn child does not have a number, you may have the baby added by sending a CF-ES 2039, Medical Assistance Referral Form (April 2003 Updated Version of the 2039) to the district Children and Families office. You will also find a copy of the referral form and instructions in the Florida Medicaid Provider General Handbook, Chapter 3.
This process will expedite the addition of newborns' eligibility to the Medicaid file and allow you to submit their bills more timely. If you have any questions, please call your area Medicaid office.
