CHDP Gateway DE Infant Enrollment Process

The state Department of Health Care Services (DHCS) implemented a method to grant immediate full-scope presumptive eligibility to infants through the CHDP Gateway electronic enrollment process when the mother is receiving MC in the month of birth. Based on an initial income screening, deemed eligible infants immediately receive full scope Medi-Cal coverage retroactive to the month of birth under Aid Code 8U (zero SOC) or 8V (SOC) instead of the standard CHDP Gateway Aid Code 8W.

DE continues until an eligibility determination is completed and MC is either approved under a different Aid Code or a denial/discontinuance is reported to MEDS.

Note: These infants may be known to us as unborns.

MEDS Alerts

MEDS alert 9034 and 9535 will be issued when an existing case is identified. The EW must review the mother’s case to determine if DE or some other MC program is appropriate. If the case is closed, it must be re-opened and the infant’s eligibility must be determined.

Note: An application will not be received from the Single Point of Entry (SPE) on these infants and we cannot require an application for the infant.

EWs must follow the steps below to clear these records:

If the Infant is…

Then the Worker must…

Already active in a case under the same

MEDS ID,
  • Determine the infant’s MC eligibility from the date of birth, and
  • Complete an SCD 1296 requesting an AP 18 transaction to deny the application (which will terminate Aid Code 8U/8V). Use the existing 14-digit County ID; Application Flag “P”, and Denial Code “L” (for an existing MC recipient).

Already active in a case under a different

MEDS ID,
  • Determine the infant’s MC eligibility from the date of birth, and
  • Complete an SCD 1296 requesting an EW 11 transaction to combine the two MEDS records, and an AP18 transaction to deny the application and terminate Aid Code 8U/8V. Use the existing 14-digit County ID, Application Flag “P”, and Denial Code “L”.

Not active, and he/she meets the criteria for Deemed Eligibility,
  • Add the infant to the mother’s case and report it to MEDS using the child’s existing CHDP Gateway MEDS ID.
  • Once the child is active on MEDS with the ongoing Medi-Cal Aid Code,

MEDS will terminate the 8U/8V record automatically (The Name, DOB and SSN MUST match to capture the same record).

Not active, and he/she does not meet the criteria for Deemed Eligibility (e.g., does not live with the mother),
  • Complete an SCD 1296 requesting an AP 18 transaction to deny the application and terminate Aid Code 8U/8V. Use the following County ID format:
    • 43-IE-xxxxxxx-y-zz

      xxxxxxx = the CalSAWS Case Number

      y= the Last Digit of the FBU

      z = the Person Number

    • and Application Flag “F.”

NOTE: Refer to the Users Guide or MEDS Quick Reference Guide for the appropriate MEDS denial code.

 

Note: When adding a newborn to a CalWORKs case, follow procedures for the Beginning Date of Aid for Newborns in the CalWORKs Handbook.

Exception Eligibles Report

These records will be added to the monthly Exception Eligibles report, if left uncleared. Infants will remain active in Aid Code 8U/8V until his/her first birthday, at which time an eligibility determination will be required for the infant, even if the case is closed.

Note: The mother’s CIN appears on the daily worker alert but not on the Exception Eligibles report. Using the daily worker alerts to initiate the follow-up process for these DE infants facilitates the process of linking the infant to the mother’s case and reporting the final determination to MEDS. Once MEDS receives the determination, the infant’s record is automatically removed from the EE report.

Related Topics

Deemed Eligibility for Infants

Safely Surrendered Baby Law