All Medicaid Programs |
Obsolete Policy |
Medicaid provides coverage during the three months immediately before the application month if the client received medical services during that time-period and meets all the eligibility criteria for such months.
The benefit effective date can begin as early as the first day of the third prior month. Always start benefits on the first day of a month unless one of the exceptions defined in 711 is true.
Benefits may begin in any of the retroactive months for which the client wants coverage and meets eligibility criteria. The client may receive Medicaid for any or all of the months in the retroactive period for which he is eligible.
If the applicant does not want coverage for any months BEFORE the month of application, begin coverage on the first day of the application month, unless specific criteria defined in 711 is not met until later in the application month. (See 711 for criteria that prevents eligibility from starting on the first day of the application month.)
If the client is not eligible for the application month, decide if the client needs retroactive coverage. The same application may be used to determine eligibility for the following month; however, the application date changes to the first day of that month. (See 711 .)
Retroactive assistance is available as follows:
No retroactive assistance is available for the QMB Program. (This is the Medicare Cost-Sharing program where income must not exceed 100% of FPL.) In fact, eligibility for the QMB program cannot begin until the month after the worker determines the individual is eligible, which means it cannot start in the application month either.
Retroactive coverage is available for the other Medicare Cost-Sharing programs for up to 3 months before the application month, subject to the exceptions noted in 711. This includes SLMB, QI and QDWI (Qualified Working Disabled Individuals).
For all other programs, retroactive coverage is available for up to 3 months before the application month, subject to the exceptions noted in 705-1.
When retroactive assistance is requested on applications taken in January, February and March, 2014, workers must apply the financial rules that were in effect in 2013. This includes verification of assets and use of actual income for eligibility in any 2013 month.