9535 - Deemed Newborn Over 10 Months, Redetermination Needed - Priority Alert

This alert is generated in the MEDS Renewal process when an infant deemed eligible via the CHDP Gateway enrollment is approaching one year of age.

Alert message 9034 was previously issued, but correction action has not been taken to add the newborn to mom’s case for Medi-Cal.

Sample Alert

Possible Screen to Resolve This Alert

The INQ1 screenThe INQ1 screen indicates more than 11 months of exception eligibility as a deemed infant.

Action Required

The EW must take IMMEDIATE action to resolve this alert by taking the following actions:

• Obtain mom’s CIN from the [INQP] screen of the newborn record and search for mom’s case number.
• Confirm whether the newborn is living with mom.
  • If the newborn is living with mom, add the newborn to mom’s case for Medi-Cal effective newborn’s date of birth. Use the correct address when adding the newborn.

IMPORTANT: When adding the newborn to mom's case, the EW must use the MEDS-ID or CIN on the newborn’s MEDS record to prevent duplicate records from being created and to terminate the Gateway record.

• If the newborn is NOT living with mom, submit an SCD 1296 requesting the MTO to terminate the CHDP-GW record.
• If the newborn is already added to the mom’s case under a DIFFERENT MEDS-ID, submit a SCD 1296 requesting an EW11 transaction to combine the two records.

Related Topics