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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 [25 KB 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 ACS State Healthcare, formerly known as
Consultec, Medicaid's fiscal agent, at 877-231-2170 to have
the coverage activated or you may mail the completed form to:
ACS State Healthcare
Recipient Support Unit
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.
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