Family and Children's Medicaid MA-3220 RETROACTIVE COVERAGE

III. PROCEDURES

A. At Application:

1. Advise the applicant of the provision for retroactive Medicaid. He may apply for prospective and/or retroactive coverage.

2. Ask the applicant if he has a medical need, as defined in II.A. during the retroactive period.

3. Accept and document the applicant’s statement as verification of medical need.

B. Separate Treatment of Retroactive Months (Not Applicable to MPW)

Consider the retroactive period separate from the prospective certification period which begins with the month of application.

1. Establish the income limit for the budget unit based on the appropriate needs section.

2. Consider only the income available to the budget unit in the month(s) of medical need.

3. For Family and Children’s Categorically Needy (CN) coverage groups (including M-IC), if there is excess income the case is ineligible. A deductible does not apply.

a. Evaluate eligibility for each retroactive month of need separately.

b. If the income in any retroactive month exceeds the income limit, evaluate that month as Medically Needy.

4. For Medically Needy (MN) coverage groups, compare the countable income and the income limit for each month of medical need to determine if excess income exists.

a. If the months of medical need are consecutive, combine the excess income for each month to obtain one deductible amount for the retroactive period.

b. If the months of medical need are not consecutive, consider each month separately and determine a deductible for each month.

5. For situations where the monthly income fluctuates in the retroactive period, treat months of CN eligibility separate from months of MN eligibility. Authorize the CN month(s) and:

a. If the MN months are consecutive, combine the excess income for each month to obtain one deductible amount for the retroactive period.

b. If the MN months are not consecutive, consider each month separately and determine a deductible for each month.

REISSUED 10/1/05 – CHANGE NO. 20-05

(III.B.)

6. If excess reserve exists throughout the retroactive period and/or a deductible is not met during the retroactive period, the individual is ineligible for the retroactive period.

C. M-PW Cases

1. If assistance is requested for the retroactive period, the base period is the first calendar month of medical need. For income which is received on other than a monthly basis (see MA-3300, Income), the base period for the retroactive period will be the same as for prospective coverage.

a. If the countable income is equal to or less than the MPW Income Limit for the first month of medical need, the pregnant woman is financially eligible for all months of retroactive need. Provided all other eligibility requirements are met, authorize assistance from the first month of medical need.

b. If countable income exceeds the MPW Income Limit for the first month of medical need:

(1) Move the base period to the next calendar month(s) of retroactive medical need. If the countable income exceeds the MPW Income Limit for that month, move the base period to the next calendar month of retroactive need. For retroactive coverage the base period can never go beyond the last month of retroactive need. Assistance can never begin earlier than the month the income is equal to or below the Poverty Income Level.

(2) If the budget unit’s verified income exceeds the MPW Income Limit for any month in the retroactive period, evaluate eligibility for retroactive coverage under MAF-MN.

2. If you verify financial need for any month in the retroactive period, the pregnant woman meets financial eligibility requirements through the postpartum period.

EXAMPLE: Pregnant woman applies in August for prospective coverage as well as retroactive coverage for June. The base period is June. If the June income verifies financial need and all eligibility requirements are met, authorize M-PW effective June 1 through the postpartum period.

3. If you cannot verify financial need for any month in the retroactive period, evaluate for prospective coverage.







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