Adult Medicaid Manual MA-2370 RETROACTIVE COVERAGE

01/01/95

I. POLICY RULES

A. Eligibility may be authorized for the 1, 2 or 3 months preceding the month of application.

B. There must have been a medical need in the retroactive period that is:

1. A medical bill which is unpaid; or

2. A medical bill which has been paid by the applicant, or someone on his behalf, for which the provider agrees to refund the payment and bill Medicaid. The refund provision does not apply to third party insurance payments because insurance must pay before Medicaid pays.

C. M-AABD MN authorization begins the day of the month the deductible is met or excess reserve is reduced, provided all other eligibility requirements are met.

D. For M-AABD CN-NMP cases:

Authorize cases with excess reserve the first day of the first month that the reserve is reduced, provided all other eligibility requirements are met.

E. For MQB-B cases authorization begins up to 3 months prior to the month of application.

F. For MQB-Q, retroactive coverage does not apply.

G. For SSI an Applicants or recipients refer to MA-1100 for instructions to determine the retro period.

H. For situations in which a medical need exists in 2 or 3 consecutive months in the retroactive period, the applicant may choose to apply for only the month(s) of his choice.







For questions or clarification on any of the policy contained in these manuals, please contact your local county office.