Medicaid Policy
Medicaid Policy
A. General Requirement
If individuals received medical services during any of the three months immediately before the date they apply for Medicaid, they may be able to receive Medicaid for some or all of that time-period. The Retroactive Period is the 3 calendar months immediately before the application month. (See Sec. 703 for a definition of an application and 703-2 to decide the date of application.)
B. Required Retroactive Eligibility
1. Retroactive eligibility must always be determined in the earliest eligible month for the following groups:
a. SLMB and QI: Determine if applicants who have Medicare are eligible for SLMB or QI benefits for any of the three months (retroactive period) before the date of application. Individuals are often unaware they can receive retroactive coverage for their Part B Medicare premiums, so they may not ask. Workers are responsible for looking at the retroactive period to see if the person qualified, even if the individual does not need Medicaid for the retroactive period, or does not choose to meet a Medicaid spenddown for retroactive months. This is because for each month of eligibility, these programs can reimburse the Medicare Part B premiums individuals have paid. (320-3, 320-4)
b. Pregnant Woman: If the applicant had Medicaid coverage in the available retro period and was pregnant during that time, then the member is entitled to Medicaid coverage for the duration of the pregnancy and its postpartum period. (See Sec. 349). If the applicant did not have any Medicaid coverage during the available retro period determine the applicant’s eligibility for the most beneficial program (345, 347, 349) for month of the application, unless:
i. She requested retroactive coverage for one or more of the three retroactive months, or
iii. If the woman does not qualify for Medicaid without a spenddown, determine eligibility for Medically Needy Pregnant Woman. If she applies after the pregnancy terminates, determine her eligibility for retroactive months in which she had the medical need.
2. Applicants that have provided verifications late but within 30 days of denial must have retroactive eligibility addressed back to their initial application date.