Iowa Admin. Code r. 441-76.13 - Initial enrollment
(1)
Enrollment date. Applicants who have been determined to be
eligible shall be enrolled by the department in the Medicaid program.
a.
First day of the month
The effective date of enrollment is the first day of the first month for which
eligibility has been determined, with the following exceptions:
(1) Presumptive eligibility is effective on
the date that presumptive eligibility was determined by a qualified entity for
presumptive Medicaid eligibility determinations.
(2) Eligibility under the qualified Medicare
beneficiary coverage group begins on the first day of the month after the month
of decision.
(3) Eligibility for
individuals approved for supplemental security income , programs related to
supplemental security income , state supplementary assistance, or medical
assistance benefits shall be effective on the first day of the month when the
individual was resource-eligible as of the first moment of the first day of the
month and met all other eligibility criteria at any time during the
month.
(4) When a request is made
to add a new person to the eligible group, medical assistance shall not be
effective before the first of the month in which the request was
made.
(5) When a request is made
prior to January 1, 2014, to add to the eligible group a person who previously
was excluded, in accordance with the provisions of rule
441-75.59 (249A), medical
assistance for the person shall be effective no earlier than the first day of
the month following the month in which the request was made.
b.
Care or services prior
to enrollment. No payment shall be made for medical care or services
received prior to the effective date of enrollment.
(2)
Certification for
services. The department shall issue a Medical Assistance Eligibility
Card, Form 470-1911, to persons who have been determined to be eligible for the
benefits provided under the Medicaid program, with the following exceptions:
a.
Presumptive eligibility .
A person who has been determined only presumptively eligible will be
issued a Presumptive Medicaid Eligibility Notice of Action, Form 470-2580 or
470-25 80(S), which will include certification information.
b.
Emergency Medicaid for
aliens. An individual who is eligible only for limited emergency
Medicaid for aliens pursuant to 441-subrule 75.11 (4) will be issued a Notice
of Action, Form 470-0485 or Form 470-0485(S), which will include certification
information.
(3)
Retroactive enrollment.
a.
Except as provided in paragraph 76.13(3)"e, " medical
assistance shall be available for all or any of the three months preceding the
month in which an application is filed to a person who was pregnant, an infant
(under the age of one), or a resident of a nursing facility licensed under Iowa
Code chapter 135C during any of the three months and who:
(1) Has medical bills for covered care or
services received during the three-month retroactive period; and
(2) Would have been eligible for medical
assistance in the month services were received if the application for medical
assistance had been made in that month.
b. The applicant need not be eligible in the
month of application to be eligible in any of the three months prior to the
month of application.
c.
Retroactive medical assistance shall be made available when an application has
been made on behalf of a deceased person who was an infant, pregnant, or a
resident of a nursing facility licensed under Iowa Code chapter 135C if the
conditions in paragraph 76.13(3)"a" are met.
d. Persons enrolled in Medicaid based on
receipt of supplemental security income benefits who wish to make application
for Medicaid benefits for the three months preceding the month of application
shall complete SSI Medicaid Information, Form 470-0364, 470-0364(S),
470-0364(M), or 470-0364(MS).
e.
Exceptions to retroactive enrollment. This subrule does not apply to the
following persons who are otherwise eligible for retroactive enrollment:
(1) Persons whose citizenship or alien status
has not been verified even though they are eligible during a 90-day reasonable
opportunity period.
(2) Persons
determined eligible only under presumptive Medicaid benefits.
(3) Persons eligible for Medicaid only under
the qualified Medicare beneficiary program.
(4) Persons eligible only under the home- and
community-based waiver services program.
Notes
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