Wiki Birthday Rule - Primary Medicaid

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Roberchelle5

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Greetings. I could use some help....I have a new born and the father is older and has Medicaid. The mother is younger and has commercial. Does the father need to establish Medicaid for the patient? Or can the mother take the child on her policy since it is private? I am a little confused because I understand that you have to bill private insurances before Medicaid. Mom said she had the baby added, but if the birthday rule and the Medicaid is primary, then why would the mom need to add her child to her commercial policy? Any help would be greatly appreciated. Thanks.
 
The birthday rule applies when the patient has coverage under both parents, to determine which is primary and which is secondary. It does not require either parent to add the child to their policy. If the patient has coverage only under her mother, then that is the policy you bill.

FYI - the birthday rule is not who is OLDER, but rather who's birthday comes first in a calendar year. Example:
Parent 1 DOB:04/30/1988. Parent 2 DOB:07/07/1984. Parent 1 is primary because April 30th is before July 7th, even though Parent 2 is older.
 
Medicaid is always the payer of last resort, so the birthday rule would not apply in this situation. If the newborn has commercial coverage, then that will be the primary payer, it doesn't matter which parent's birthday is first, the Medicaid will still be secondary. The birthday rule only applies when a patient has two commercial plans, one from each parent.

But just because the father has Medicaid does not mean that the child will be eligible. Medicaid would have to make a separate determination as the child's eligibility. The child possibly won't be eligible due to the fact that the mother is able to provide coverage on her plan.
 
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