Pregnant Members and Infants. (1) The HHSC Administrative Contractor will refer pregnant CHIP Members, with the exception of Legal Permanent Residents and other legally qualified aliens barred from Medicaid due to federal eligibility restrictions, to Medicaid for eligibility determinations. Those CHIP Members who are determined to be Medicaid Eligible will be disenrolled from HMO’s CHIP plan. Medicaid coverage will be coordinated to begin after CHIP eligibility ends to avoid gaps in health care coverage.
Pregnant Members and Infants. (1) If notified of a CHIP Member's pregnancy prior to birth, the HHSC Administrative Contractor will refer pregnant CHIP Member to Medicaid for eligibility determination (with the exception of Legal Permanent Residents and other legally qualified aliens barred from Medicaid due to federal eligibility restrictions). Those CHIP Members who are determined to be Medicaid Eligible will be disenrolled from HMO’s CHIP plan. Medicaid coverage will be coordinated to begin after CHIP eligibility ends to avoid gaps in health care coverage.
Pregnant Members and Infants. The HHSC Administrative Contractor will refer pregnant CHIP Members, with the exception of Legal Permanent Residents and other legally qualified aliens barred from Medicaid due to federal eligibility restrictions, to Medicaid for eligibility determinations. Those CHIP Members who are determined to be Medicaid Eligible will be disenrolled from HMO’s CHIP plan. Medicaid coverage will be coordinated to begin after CHIP eligibility ends to avoid gaps in health care coverage. In the event the HMO remains unaware of a Member’s pregnancy until delivery, the delivery will be covered by CHIP. The HHSC Administrative Services Contractor will then set the Member’s eligibility expiration date at the later of (1) the end of the second month following the month of the baby’s birth or (2) the Member’s original eligibility expiration date. Most newborns born to CHIP Members or CHIP heads of household will be Medicaid eligible. Eligibility of newborns must be determined for CHIP before enrollment can occur. For newborns determined to be CHIP-eligible, the baby will be covered from the beginning of the month of birth for the period of time specified in the evidence of coverage.
Pregnant Members and Infants. Becoming pregnant, in and of itself, does not make a Member ineligible for CHIP. If, after becoming pregnant, a Member chooses to apply for Medicaid and is determined to be Medicaid-eligible, she is no longer eligible for CHIP. The Administrative Services Contractor will notify the Member about her potential Medicaid eligibility and of her ability to apply for Medicaid and will provide appropriate resource information. Infants are automatically enrolled in the mother's CHIP health plan at birth with CHIP eligibility and reenrollment following the same time frame as those of the mother. CONTRACTOR through electronic means or the providers through calls to the provider hotline will notify the Administrative Services Contractor when a pregnancy is diagnosed. The administrative services contractor will deem the pregnant Member to be eligible for CHIP services under a new period of continuous coverage. The coverage will extend from the date of notification of the pregnancy through the later of: (1) the last day of the second month following the month of the baby's birth, or (2) the date when the mother's eligibility would have expired under the original twelve-month period of continuous coverage. To further ensure the reliability of the data, families also will be encouraged to notify the Administrative Services Contractor by phone or in writing when delivery of a baby to a CHIP-enrolled Member occurs.
Pregnant Members and Infants. CONTRACTOR, through electronic means, or the providers, through calls to the provider hotline, will notify the Administrative Services Contractor when a pregnancy is diagnosed. Pregnant members, with the exception of Legal Permanent Residents and other legally qualified aliens who are not barred from Medicaid due to federal eligibility restrictions, will be referred to Medicaid for eligibility determination. Those members who are determined to be Medicaid eligible will be disenrolled from the CONTRACTOR. Medicaid coverage will be coordinated to begin immediately after CHIP eligibility ends so that there is no gap in health care coverage. In the event the CONTRACTOR remains unaware of a member’s pregnancy until delivery, the delivery will be covered by CHIP. The Administrative Services Contractor will suspend the Member’s eligibility expiration date after notification of the delivery is received. The Administrative Services Contractor will unsuspend the mother’s eligibility expiration date and set the mother’s eligibility expiration date at the later of (1) the end of the second month following the month of the baby’s birth or (2) the date when the mother’s eligibility would have expired if it had not been suspended during her pregnancy. To further ensure the reliability of the data, families also will be encouraged to notify the Administrative Services Contractor by phone or in writing when delivery of a baby to a CHIP-enrolled Member occurs. Most newborns born to CHIP members or CHIP heads of household will be Medicaid eligible. Eligibility of newborns must be determined for CHIP before enrollment can occur. The CHIP Administrative Services Contractor should be notified as soon after delivery as possible. For newborns determined to be CHIP-eligible, the baby will be covered from the beginning of the month of birth.
