Medicaid for Newborn Babies: What You Need to Know

For many people, becoming a parent or caretaker for a newborn can be a challenging process. As you begin this journey with your new arrival, there’s a laundry list of things to learn and worry about. It can feel like you’re on a crash course as you try to figure everything out — and quickly, too. 

Though immediate needs like learning how to feed and bathe are likely at the top of the list, so is making sure your baby has the healthcare coverage they will need. Medicaid for newborn babies allows you to make sure your baby has healthcare even if you don’t have private insurance. 

You want to make sure your baby can get their well-baby visits to the pediatrician and needed vaccines too. And hopefully, they won’t get sick, but if they do, you want to make sure you can get them to the doctor to get the care they need. 

Medicaid for newborn babies can provide your infant with the medical care they’ll need. Read on for a Medicaid guide for your baby, including how to get Medicaid and what coverage you’ll get for your baby.

What Is Medicaid?

Medicaid is a federal and state program available to low-income US citizens who need healthcare coverage. It’s available to a number of Americans, including children, pregnant women, parents, seniors, and individuals with disabilities who have limited income or resources available to get their own private healthcare insurance. 

72.5 million Americans are able to take advantage of Medicaid, which makes it the largest healthcare resource in the US. It works with the Children’s Health Insurance Program (CHIP) program to provide coverage for children, including newborns. 

Medicaid and the CHIP program are federally funded, yet benefits and eligibility requirements are handled by states. 

A pregnant woman who is on Medicaid will automatically have coverage for her newborn when she delivers for the first year of the baby’s life. 

Children’s Health Insurance Program (CHIP) Program

About 9.6 million children have benefits through the CHIP program. This healthcare coverage is available to newborns and children through both Medicaid and separate CHIP programs.

Its funding for the program comes from both the federal government and states. Individual states administer the CHIP program based on requirements from the federal government.

CHIP is often used for children whose families don’t meet eligibility for Medicaid because their income is too high. Yet, for many states, their Medicaid coverage for newborns and children falls under the umbrella of CHIP. So while a child might be getting Medicaid coverage, the state will refer to their coverage through the CHIP program. 

The only time this really matters is if you are covered by CHIP but not by Medicaid. Remember, sometimes if your income is too high for Medicaid, you can still qualify your child through CHIP.

Medicaid Eligibility for Newborns

Eligibility for Medicaid is based on income. States will use the federal poverty level (FPL) to base their eligibility on a percentage of the FPL. 

For example, if you live in California for children ages zero to one year of age the percentage 261% of the FPL. In Connecticut it’s 196%, Florida, 206%, and in Minnesota it’s 283%. 

Remember though, a newborn whose mother was already on Medicaid is automatically covered for the first year after being born. A state should not require the newborn to do a new application or complete a new eligibility determination.

The percentage of the FPL for newborns would only matter if the mother wasn’t qualified at birth and was trying to get coverage from Medicaid after the baby was born.

Medicaid Coverage for Newborns

Your newborn will have some medical needs and you want to know what coverage you have available. Remember, Medicaid covers certain things mandated by the federal government. The CHIP program coverage varies from state to state, although the federal government mandates certain benefits for newborns.

Let’s take a closer look at what mandated benefits are available for your newborn. 

Well-Baby Visits

Your baby will need to go to the doctor when they are well and not just when they are sick. These are called well-baby visits and are mandated for coverage under both Medicaid and CHIP. 

During a well-baby visit, the doctor can check the baby’s overall development and growth. They can also monitor the meeting of developmental milestones. These visits are an important screening tool for any potential issues that might arise. 

Most states will use the American Academy of Pediatrics guidelines for how often a baby and child should have a well-visit to their pediatrician.

Vaccines

Over the first 18 months of your baby’s life, they’ll need a whole list of vaccines. The vaccines are usually part of the well-baby visits. Both Medicaid and CHIP are required to provide vaccine coverage. 

What’s most important for you to know as the parent or caretaker of an infant is that you can get your child the vaccines they need and know they will be covered through their Medicaid/CHIP coverage. 

The states and the federal government have a whole host of guidelines for who pays for vaccines and under what coverage. This really has to do with what program funds the vaccine. You just need to know if your child qualifies for Medicaid, their vaccines will get covered too.

Behavioral Health Benefits

You might not imagine a scenario where your newborn will need mental health services. It is possible, however, so Medicaid and CHIP are required as part of the Mental Health Parity and Addiction Equity Act. This act prohibits discriminatory practices in insurance from limiting coverage for behavioral health services. 

Dental Benefits

Again, you might not be thinking about dental care when you have an infant, but the coverage is there. Medicaid and CHIP must provide coverage “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions”.

Enrollment for Benefits

The federal government allows the states to establish several options for enrollment into both Medicaid and CHIP. Remember, if you have coverage when your baby is born, your newborn will have coverage automatically for the first year. 

States can implement express lane eligibility (ELE) for those who aren’t born with coverage. This allows the states to quickly grant eligibility using findings for income and household size as factors.

States can also offer what’s called continuous coverage to children up to the age of 12 even if the status of income or eligibility factors have changed for the family. This is true for both Medicaid and CHIP.

States can also provide what’s called presumptive eligibility under CHIP or Medicaid through the federal government. This allows states to use title XXI funds to pay costs of CHIP coverage. 

Getting the Things Your Baby Needs

Not only is having a baby exciting, and let’s face it exhausting too, it’s also expensive. You won’t be the first parent or caretaker ever to marvel at how a human who is so little can need so much stuff. Babies are expensive. From clothes and diapers to cribs and car seats, it can feel draining or even impossible to plan for and acquire everything they need before they’re born and during the first year of their life. 

If you’re a low-income parent or caretaker, the many needs of a baby can feel daunting. Luckily, there are additional services available for you so you can get the things you need for your baby. 

In addition to healthcare and baby formula, you’ll quickly notice how many diapers you go through in a day or week. Diapers can be quite expensive, but there are a variety of resources for low-income families to get free diapers to help with their baby’s care.

Beyond diapers and formula, there are other needs too. Your baby will need a crib of their own and a car seat. You should never buy a used car seat. You don’t know if its safety standards are up to date or the car seat has ever been in an accident. 

If you need some additional assistance for those items and others your baby will need, there are also many programs available to help you get everything your baby will need to be safe, cared for, and healthy.

Understanding Medicaid for Newborns

Medicaid for newborns helps to make sure your newborn gets the healthcare services they need during the first year of their life. It’s also a relief to you to know they have coverage and get taken care of by a doctor. 

It’s important to make sure you get regular well-baby visits and vaccines for your infant. Knowing you have the coverage your baby needs makes going to the doctor much easier. 

Before the first year of their life goes by, be sure to check on continuing their coverage through either Medicaid or the CHIP program so they don’t lose benefits once they celebrate their first birthday.

Save Money on Your Wireless Phone Service

If you qualify for Medicaid benefits, you also qualify for Lifeline service. Lifeline is a federal benefit program that makes it possible for low-income consumers to receive access to free or heavily discounted communication services. Click here to find out more and apply for this valuable benefit.