Family and Children's Medicaid MA-3220 RETROACTIVE COVERAGE

II. REQUIREMENTS

A. In order get retroactive Medicaid, there must have been a medical need in the retroactive period that is:

1. An unpaid medical bill; 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; or

3. A service provided to a pregnant woman receiving prenatal care from a county health department or other public clinics. She may or may not have a bill for these services.

B. For MAF-C or N cases, authorization begins the day of the month all eligibility factors are met.

C. For M-AF MN cases, 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 BCCM cases, retroactive coverage only applies if as of the earlier date, the woman met eligibility requirements. This includes having been screened and found to need treatment for breast or cervical cancer in the retroactive month.

E. For M-PW and M-IC cases, authorization is for the full month in which all eligibility factors are met. If the budget unit’s income exceeds the income level for a retroactive month, it is ineligible for that month. Evaluate eligibility under another coverage group.

F. For situations in which a medical need exists in 2 or 3 consecutive months in the retroactive period, evaluate with the applicant the months for which he should request assistance. See III.B.4.

REISSUED 11/01/09 – CHANGE NO. 12-09