Medicaid Policy
Medicaid Policy
Contact DHHS Policy Specialist for Previous Policy
In general, bills incurred during the retroactive period are processed and paid the same way current bills are paid. However, there are some issues that can affect what bills may be paid. Before individuals pay a spenddown or MWI premium for retroactive coverage, they should be aware of the following issues.
Providers are not required to accept Medicaid after they have already provided services; however, many providers will. If an individual wants coverage for any part of the retroactive period and will have a spenddown or MWI premium to pay to be eligible, workers should tell the individual to first see if the providers will accept the Medicaid card.
Retroactive assistance will not pay for medical expenses unless the individual becomes Medicaid eligible for the dates the individual received the medical services. Medicaid will not pay any medically necessary medical bills for services received before the benefit effective date. Use such bills to reduce or meet the spenddown, if one is owed. When an applicant owes a spenddown or MWI premium for retroactive months, help the individual decide if the medical costs incurred in the retroactive month on or after the benefit effective date exceed the spenddown or premium. Allow deductions for medical services received in a month before the benefit effective date, if applicable, when calculating the spenddown. (See Sec. 460)
Medicare premiums for retroactive months will be paid in full for Medicaid, SLMB and QI-1 recipients even when the benefit effective date is other than the first day of the month.
The Medicaid claims payment system does not usually pay bills unless providers submit the bills within 12 months of the date of service. When approving coverage for the retroactive period or for any other past months, that include any coverage dates that are twelve or more months before the approval date, take the following steps:
Send a notice in addition to your Medicaid approval notice. On this notice, include the names of the eligible members and the dates of eligibility being approved.
The member needs to take the above notice and the Medicaid card to providers who have bills to submit to Medicaid that are over 12 months old. This notice includes information the provider needs to send in bills for payment. It also tells providers that Medicaid may not pay bills older than 12 months and will not pay bills that have been used to meet a Medicaid spenddown.
The case name and number
What past months of Medicaid have been approved and for whom
Why Medicaid was approved for months that are more than 12 months ago