Retroactive Medicaid Eligibility

Retroactive Medicaid Eligibility A. Retroactive Medicaid eligibility may be available to any Medicaid applicant who received medical care prior to applying for Medicaid. B. Retroactive eligibility may include all three (3) or any of the three (3) months prior to the month of application. In addition: 1. Each Applicant is informed of the availability of retroactive Medicaid coverage. 2. The applicant’s statement is accepted regarding medical expenses incurred in the retroactive period. 3. Retroactive Medicaid may also be available to an individual who is added to a case such as a child who returns home. 4. The applicant does not have to be eligible in the month of the application or even the current month to be eligible for one (1) or more months of retroactive Medicaid. 5. The applicant or beneficiary may ask for retroactive Medicaid coverage at any time. 6. The date of application, rather than the date of the eligibility determination, establishes the beginning of the three (3) month retroactive period. 7. There is no provision for retroactive coverage in the Qualified Medicare Beneficiary (QMB) program. QMB eligibility begins the month following the month of authorization. QMBs cannot be placed into a Specified Low-Income Medicare Beneficiary (SLMB) or Qualified Individual (QI)-1 category of eligibility to provide retroactive payment of Medicare Part B premiums for the retro period. 8. Hospital Presumptive Eligibility (HPE) has no retroactive coverage. If a full application for Medicaid is filed and approved, retroactive Medicaid is available for up to three (3) months prior to the month the full Medicaid application is filed. 9. Presumptive Eligibility for Pregnant Women (PEPW) does not provide retroactive coverage. If a full application for Medicaid is filed and approved, retroactive coverage is available for up to 3 months prior to the month the full Medicaid application is filed.