Medicaid Policy
Medicaid Policy
Determine the benefit effective date of coverage for Medicaid, Medicaid Work Incentive, Medicaid Cancer Program, SLMB, QI, and Qualified Disabled Working Individuals (QDWI) as described below.
Application Month
The benefit effective date is the first day of the application month for each person who is determined to be eligible at any time during the month, even if the person was not eligible at the time of application, unless one of the exceptions below is true.
If the applicant is not eligible for the application month, the same application can be used to determine eligibility for the following month. When denying the original application month and determining eligibility for the next month, the application date and the benefit effective date changes to the first day of that next month, subject to the following exceptions. This also changes the retroactive period. In this case, decide if the member wants retroactive coverage based on the original application date so as not to lose possible months of coverage.
(Refer to 503-2 for the resource test for the aged, blind and disabled.)
EXCEPTIONS to benefits starting on the first day of a month:
The individual moved to Utah to take up residency during the application month, in which case eligibility cannot begin before the date the person arrived in Utah.
The individual is a qualified non-citizen who was subject to the five-year bar for Medicaid and the five-year bar ended during the application month, in which case eligibility cannot begin before the date the five-year bar ended.
The individual became a qualified non-citizen who is not subject to the five-year bar during the application month, in which case eligibility cannot begin before the date the individual became a qualified non-citizen.
The person is released from a Utah jail or prison or discharged from the State Hospital or other IMD. (Sec. 703-7)
Retroactive Period
The benefit effective date for an applicant who requests retroactive coverage cannot be earlier than the first day of the third month before the month of application. (See sec. 703-2 for date of application) For example, if someone applies on July 15, the benefit effective date cannot begin earlier than April 1st. There are four exceptions to the benefit effective date starting on the first of the month in the retroactive period. They are:
The individual moved to Utah to take up residency during the retroactive month, in which case eligibility cannot begin before the date the person arrived in Utah.
The individual is a qualified non-citizen who was subject to the five-year bar for Medicaid and the five-year bar ended during the retroactive period, in which case eligibility cannot begin before the date the five-year bar ended.
The individual became a qualified non-citizen who is not subject to the five-year bar during the retroactive month, in which case eligibility cannot begin before the date the individual became a qualified non-citizen.
The person was released from a Utah jail or prison or discharged from the State Hospital or other IMD in the retroactive month. (Sec. 703-7)
Eligibility workers must determine eligibility for retroactive months for the SLMB and QI programs without a request from individuals when the individual was eligible for Medicare in those months.
Cancer Program
For the Cancer Program, retroactive coverage cannot begin before the month the woman was screened and diagnosed by a CDC provider.
Adding Infants
If the child was born to a mother on Utah Medicaid, add the child back to the date of birth, regardless of date of report.
If the child was not born to a mother on Utah Medicaid, the following apply:
If the birth was reported timely, add the child back to the date of birth.
If the birth was not reported timely, add the child the month of report, but not prior to the date of birth.
Determine retroactive eligibility from the date of report.
Ongoing Months
For all ongoing months after the application month is approved, eligibility begins on the 1st day of the month and extends through the end of the month. This applies even when the recipient meets the spenddown or MWI premium after the first day of the benefit month. See 705-1 to determine the retroactive period.