Provider Alerts

As recently communicated by Health Plan, effective July 1, 2024, Assembly Bill 118, Chapter 42, Statutes of 2023, requires providers participating in the Presumptive Eligibility (PE) program to report the births of newborns with linkage to Medi-Cal and the Medi-Cal Access Infant Program born in their facilities within 72 hours after birth or 24 hours after discharge, whichever is sooner, via the Newborn Gateway.

Requirements for Qualified Providers (QPs) submitting Newborn Gateway applications using placeholder information have been updated. QPs do not need to retake the certification training but should be aware of the following updates.

Submitting Placeholder Information on Application

When submitting a placeholder for newborn’s first name, QPs should use “Baby Boy” or “Baby Girl” in lieu of “#” when the newborn’s first name is undecided.

Whenever an application is submitted with placeholder details, staff must contact the family directly and let them know they will need to provide the newborn’s Social Security Card to either their county Medi-Cal office or the Medi-Cal Access Program (depending on program eligibility), so that staff can amend the record and issue a corrected insurance card.

Communicating Information to Families

Newborn Gateway workflows should ensure sufficient information is communicated directly to the family, whether they are present during the Newborn Gateway enrollment transaction or not. The family must be provided a copy of the Immediate Need document, which includes the Benefits Identification Card (BIC) ID, and a copy of the Newborn Gateway application. If the family is absent during the enrollment transaction, these documents must be mailed along with a written explanation of the below information.

In all cases, staff should provide the family an explanation of the following:

• The outcome of the Newborn Gateway application (approved or denied).
• Reason for denial, if applicable, and ability to still submit an insurance affordability application.
• Which case management entity to contact with questions or to update information (for example, address).

In all cases where eligibility is approved, staff should provide the family an explanation of the following:

• The BIC ID number and an explanation of the ability to use it to seek services immediately.
• That a plastic BIC card will arrive at the address listed on the Newborn Gateway application within 10 business days.
• The eligibility period, which shall last until the newborn’s first birthday with few exceptions.

In all cases where eligibility is approved and placeholder information is used, staff should provide the family an explanation of the following:

• The exact placeholder information used (for example, mother’s last name for newborn’s last name).
• That the family must contact the case management entity to amend the name and that the case management entity may request additional verification to amend the name.
• Which case management entity to contact to amend the name (for example, the county or Maximus).

In all cases where eligibility is denied and placeholder information is used, staff should provide the family an explanation of the following:

• The exact placeholder information used (for example, mother’s last name for newborn’s last name).
• The BIC ID associated with the newborn’s denied eligibility.
• That the family should save the BIC ID and report it to the eligibility worker when applying for coverage in the future.

For more information on the Newborn Gateway, please visit:  https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/79DA7CFA-1D19-4C79-8DB7-29EF92A6A1A0/user-guide-newborn-gateway.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO

If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org