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Determining Eligibility for Retroactive Medicaid Coverage

Providing an applicant meets the requirements for eligibility, unpaid health care costs incurred during the three months prior to application for Medicaid benefits are covered as Medicaid retro coverage. The precise date of eligibility for retroactive Medicaid coverage is based on the date of application for Medicaid, not the date that one’s eligibility is determined to be valid.

How to Apply for Medicaid Retro Coverage

To apply for retroactive Medicaid coverage, obtain an application from a hospital, Medicaid office or by downloading an application from the internet, then fill out the application and return it to a Medicaid office. Include copies of the necessary documentation and be sure to keep appointments for interviews or follow-ups.

Who May Apply for Medicaid Retro Coverage?

Retroactive Medicaid coverage is available to eligible persons who did not file an application for Medicaid until after they received health care, because they were unaware that Medicaid coverage was available to them, or because they were unable to file an application due to illness, injury or hospitalization.

Retroactive Medicaid coverage may also apply in cases of deceased persons.

What is the Scope of Medicaid Retro Coverage?

The scope of Medicaid coverage during the retroactive period is equivalent to the services that other Medicaid beneficiaries received during the same period. That is, retroactive coverage for eligible Medicaid beneficiaries is not diminished.

Retroactive Medicaid is applied only towards unpaid health care expenses incurred by enrolled providers during the three months that retroactive benefits apply. In other words, if health care services received during the three-month period have already been paid at the time of application for retroactive Medicaid, then Medicaid will not reimburse for those services.