23 Miss. Code. R. 101-7.4 - Retroactive Medicaid Eligibility

A. Retroactive Medicaid eligibility may be available to any Medicaid applicant who received medical care prior to applying for Medicaid.

B. Applicants may qualify for coverage for a three (3) month period prior to the month of the application.

C. Retroactive eligibility can cover all three (3) months of the prior period or any month(s) in the three (3) month period. In addition:

1. Each Applicant must be informed of the availability of retroactive Medicaid coverage.

2. The applicants statement is accepted regarding medical expenses incurred in the retroactive period.

3. Retroactive Medicaid may also be available to an individual who is added to a case. (e.g. child returns home).

4. The applicant does not have to be eligible in the month of the application (or current month) to be eligible for one or months of retroactive Medicaid.

5. The applicant or recipient may ask for retroactive Medicaid coverage at any time.

6. The date of application, rather than the date of the eligibility determination, establishes the beginning of the three-month retroactive period.

7. There is no provision for retroactive coverage in the Qualified Medicare beneficiary (QMB) program. QMB eligibility begins the month following the month of authorization. It is not appropriate to place a QMB-only approval into an SLMB or Ql-1 category of eligibility to provide retroactive payment of Part B premiums for the retro period.

Notes

23 Miss. Code. R. 101-7.4

42 CFR § 435. 915 (Rev. 2012).