Title 16
16000 Federal Poverty Level Related Programs
16280 Deemed Eligibility of Newborns
An infant born to a woman eligible for and receiving Delaware Medicaid (including emergency services and labor and delivery only coverage) on the date of the child's birth is deemed to have filed an application and been found eligible on the date of birth and to remain eligible for 1 year provided:
• the child resides continuously in the mother's household, and
• for children born on or after January 1, 1991, the mother remains eligible for Medicaid or would have remained eligible if she were still pregnant.
For purposes of deemed eligibility, the newborn will be considered to be a member of the mother's household even if the baby is continuously hospitalized after birth, unless the mother has legally relinquished control of the child.
Newborns who are deemed eligible do not have to provide or apply for a Social Security number until the child turns age one.
A mother (who is not required to enroll in the Diamond State Health Plan) can apply after a child is born and we will determine three month retroactive coverage. If the mother is determined retroactively eligible in a month prior to the birth (still pregnant), or in the month of birth, the baby will be deemed eligible for one year.
If the mother is eligible for enrollment in the Diamond State Health Plan she cannot apply for retroactive coverage. She must apply for and be found eligible for Medicaid in the month of birth or in a month prior to the month of birth (while still pregnant) in order for the newborn to be deemed eligible. If the newborn is not deemed eligible, a separate eligibility determination must be made.
16280.1 Continuous Eligibility of Newborns
Changes in mother's family income never affect the infant's deemed eligibility because if still pregnant, the mother would remain eligible regardless of changes in income. No infants under age one should lose coverage due to household income.
