All Medicaid Programs |
Obsolete Policy |
Policy Effective July 1, 2016 - February 28, 2017 (356-1 was combined into 356 as of March 1, 2017)
What is the Baby Your Baby (BYB) Program?
The Baby Your Baby program is a Medicaid presumptive eligibility program for pregnant women. Baby Your Baby allows low income pregnant women to receive temporary medical assistance while the eligibility agency (The Department of Workforce Services-DWS) determines eligibility for ongoing Medicaid.
The Department has designated qualified health care providers to determine Baby Your Baby eligibility for pregnant women.
Application
The BYB application is a separate application from ongoing Medicaid.
Eligibility Requirement
To qualify for the BYB program, a pregnant woman must meet the following requirements based on preliminary information received by qualified providers:
Be a U.S. citizen or a qualified alien, or a lawfully present child (205-2.1)
Be a Utah resident
Have a gross household income at or below 139% of the federal poverty limit
Child support and educational income are not countable sources of income.
Be pregnant
Must not already be covered on Medicaid, CHIP, UPP, or PCN or approved for Medicaid with a spenddown
Must not have received a denial for Medicaid, CHIP, UPP, or PCN within the past 30 days unless the household circumstances have changed.
Must not have received Baby Your Baby for the current pregnancy.
There is no resource test.
It is optional for the client to provide TPL (Third Party Liability) information. TPL information is not an eligibility requirement for BYB; do not deny BYB for failure to provide TPL.
Household Size
The following individuals who reside together must be counted in the household when determining the household size for BYB.
If the BYB application is for a customer who is age 19 and older, count the following individuals in the household size:
Applicant
Applicant’s spouse
Applicant’s child(ren) under age 19, including the unborn child(ren)
Applicant’s step children (under age 19)
If the BYB application is for a customer who is under age 19 and lives with his or her parents, count the following individuals in the household size:
Applicant
Applicant’s spouse
Applicant’s child(ren) under age 19, including the unborn child(ren)
Applicant’s step children (under age 19)
Applicant’s parents
Applicant’s siblings (under age 19)
Whose Income to Count
Count the gross income (before taxes) of everyone that is included in the household size for the specific program with the following exceptions:
Do not count the income of a child to another child (sibling)
Do not count the income of a child to a parent
Do not count the income of a guardian to the child(ren) that the guardian is responsible for.
Exempt Income
The following types of income are exempt when determining eligibility for BYB.
Veteran's income
Educational income
Child support
Baby Your Baby Determination for Pregnant Woman
Qualified providers must notify the Department of the BYB decision within 5 business days from the date of determination.
The applicant must provide all BYB information in order for qualified providers to process the application.
The BYB determination is based on the customer’s declaration. No verifications are needed.
A customer is limited to one BYB eligibility period for any single term of pregnancy.
Baby Your Baby Period of Eligibility
BYB begins on the day a qualified provider determines a customer is eligible for BYB.
BYB ends on the earlier of:
The day DWS completes an eligibility decision for medical assistance, or
The last day of the month following the month BYB was approved.
BYB Extension
When the customer applies for medical assistance during the BYB eligibility period and more time is needed to determine medical assistance eligibility, the worker must grant a monthly extension.
Notices
If a woman is determined eligible for BYB, notify the woman that:
If she does not file an application for Medicaid by the last day of the next month, her BYB ends; and
If she does file an application for Medicaid by the last day of the next month, her BYB may continue until a determination of her eligibility based on that application is made.
If a woman is determined ineligible for BYB, notify the woman:
Of the denial reason, and
That she may file an application for Medicaid if she wishes to have a formal determination and where she can apply.
Notice and Appeal Rights
If a BYB eligible woman fails to file a regular Medicaid application, no action is needed when her presumptive eligibility ends. In this case, the recipient was covered under a special time-limited status. Because she was never actually determined eligible for Medicaid, the notice and appeal rights of the Medicaid program do not apply.
If a BYB eligible woman files a regular Medicaid application, the standard notice and appeal rights apply.