Retroactive Medicaid eligibility, also known as recovery service, is beneficial for patients in need of home care and nursing. With retroactive Medicaid recovery service, patients can receive coverage upto 3 months before filing the application. On the contrary, when a patient does not have retroactive eligibility, they get the benefits only from the beginning of the month or from the date of the application filing process.
Retroactive eligibility pertains to programs related to age, blindness, and disability. In some states of the USA, it is applicable for HCBS (home and community-based services) and Medicaid waiver programs. The federal regulation has declared to prolong the retroactive eligibility for Medicaid for three months. However, a few states in the USA have attempted to change the rule of the federal regulation with Section 1115 Demonstration Waivers. Eligibility for retroactive Medicaid recovery service is calculated for every month separately. An example to illustrate how it works is:
A person gets admitted to a nursing home in June and files their Medicaid application in September. Medicaid will pay the charges for the nursing home if they are found eligible with the retroactive period between 1st of June to 31st of August.
Services Covered by Retroactive Medicaid
A Retroactive Medicaid recovery service will bear unpaid medical bills along with a few other services. Apart from skilled nursing home care, the other Medicaid services are:
There are some states in the USA which cover HCBS via Medicaid waivers. If an applicant is ineligible for a specific month when calculating the Medicaid coverage, that particular month goes uncovered.
Retroactive Medicaid recovery service is for patients who get an unexpected injury or illness and need financial help. As a health emergency comes without anticipation, retroactive Medicaid is a necessity for everyone. It covers and provides the expenses for medical bills and mainly benefits the senior citizens. In order to emphasize the importance of Medicaid coverage, consider the following scenario:
Imagine a person falls and breaks their hip; without pre-planning, a financial requirement arises to meet the medical expense. In the case of elderly adults, a few may never be able to recover completely. As retroactive Medicaid recovery service provides three months’ coverage even before applying, it is the best for unexpected health problems.
Filling and fulfilling a Medicaid application is not as easy as it sounds. It is lengthy, complicated, and time-consuming. However, with eligibility, a patient will be able to cover their medical expenses before the application filing process. Remember that the application filing process has a time frame, and one must complete the paperwork before the allotted period. The advantage of retroactive Medicaid recovery service is that it can be applied even for a dead person by their beloved ones. Some states in the USA will reimburse paid bills, while others will cover only unpaid medical expenses.
State Restrictions on Retroactive Eligibility
Retroactive eligibility is mandated by federal law, and still, certain states in the USA try to change it by identifying the loopholes to limit and restrict it. With Section 1115 Demonstration Waivers, certain states are gaining flexibility in their Medicaid programs. A classic example is Georgia which has eliminated its retroactive Medicaid recovery service in a few groups except in blind, disabled, and aged. At the same time, Arizona and Florida have changed the timeframe of the retroactive eligibility to 30 days instead of 3 months. Therefore, it provides coverage only from the beginning of the month when filing happens.
A few states have reduced the retroactive eligibility for the Medicaid beneficiaries of the nursing home. In 2019, Florida limited the retroactive eligibility to children below 21 and pregnant women. On the contrary, Arizona has limited the retroactive eligibility in all groups except in children below 19 and pregnant women in the same year. The rules and regulations revolving around a state’s Medicaid program keep changing from time to time. States may eliminate a few groups at some point but may reinstate them soon.
In order to qualify and be eligible for retroactive Medicaid, certain criteria are to be fulfilled. They are:
The figures mentioned above for a retroactive Medicaid recovery service are true for most states in the USA, but the limit differs from place to place. There maybe cases where the applicant will be eligible for all three months or only one or two months. This depends purely on the circumstance, and every state has a unique set of eligibility requirements. Beyond fulfilling the financial criteria, an applicant should have a functional need for every nursing home care.
How to Apply?
The filing process for retroactive Medicaid recovery service varies from state to state. The application form may contain a simple checkbox or an additional form to complete the filing process. The real challenge lies in collecting supporting documentation to claim the retroactive period. Solid evidence showing the medical condition and documents showing financial status are two important documents for claiming eligibility. The applicant has to wait patiently to gain coverage for the unpaid medical bills until the healthcare provider grants the eligibility. The healthcare provider is solely responsible for agreeing to offer coverage for unpaid bills. Medicaid is a unique health policy in the USA as one can file Medicaid even for a dead person to acquire eligibility and cover their unpaid bills.
All You Need to Know About Assistance Options
While applying for Medicaid, you can reach out to free public services or private professionals with service charges for assistance. As Medicaid planners have ample knowledge about rules and the entire filing and documentation processes, it is best to seek their guidance. Planners make sure that the candidates do not get themselves disqualified from the retroactive Medicaid recovery service inadvertently. Finally, once the applicant gains eligibility, presenting the approval copy to the healthcare provider is necessary so that they attach it to the claim. Remember that not all healthcare providers in the USA accept Medicaid and retroactive eligibilities.
Now that you know how retroactive eligibility works, it is always best to plan for long-term care Medicaid. Pre-planning allows candidates to use the strategies to meet the limits when drawing more income or having resource restrictions. CoverMe is a renowned front end RCM solution provider and helps you meet Medicaid’s financial guidelines. Our safety net program ensures that no payer sources are missed and offers Medicaid and private insurance coverage options.