CMS to End Medicaid Restrictions on Newborn Coverage

Under an interim final rule, Medicaid now will automatically deem a newborn eligible for one year of coverage if emergency Medicaid covered the mother's labor and delivery, according to Leslie Norwalk, acting administrator of CMS.

In a March 20 statement announcing the pending interim rule, Norwalk said the new regulation would allow babies whose deliveries are covered by Medicaid to remain eligible, "under certain circumstances," for Medicaid coverage for up to a year after their birth. She did not define those circumstances.

"Any newborn whose mother files an application and is determined eligible for emergency Medicaid for the delivery could be deemed eligible for their first year of life," CMS said in its announcement.

The new rule revises the current regulation, which denies Medicaid coverage to newborns unless their immigrant parents can prove the children's U.S. citizenship, identity and eligibility for the program. Under the current rules, parents must show two forms of identification:

AAFP President Rick Kellerman, M.D., of Wichita, Kan., praised the announcement. "This would be a good policy," he said. "We know that giving infants and children care cuts down on problems in the long run. This interim rule will help physicians provide good, basic preventive medical care and a cost saving at the same time."

In an Oct. 12, 2006, letter (PDF file: 2 pages / 23 KB. More about PDFs.) to then-CMS Administrator Mark McClellan, M.D., Ph.D., the Academy and five other medical organizations had urged CMS to "instruct the states that they should continue to deem (newborns) eligible if born to mothers receiving emergency Medicaid."

"It must be remembered that the children in question are citizens born in U.S. hospitals whose births are already paid for by state Medicaid programs," the letter said.

Sen. Charles Grassley, R-Iowa, recently agreed with the organizations' stance. "In this case, I believe CMS has gone too far," he said in remarks made to Congress when he introduced the Guaranteed Access to Medicaid for Newborns Act, or S. 751, on March 2. The bill would grant a year of Medicaid coverage to any infant whose mother qualified for emergency Medicaid during labor and delivery.