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MEDICAL SERVICES POLICY MANUAL,SECTION A

A 200 Health Care Coverage Periods

A-210 Retroactive Eligibility MS Manual 01/01/22 Refer to Health Care Procedures Manual for more information. The State is required to provide retroactive eligibility for up to three (3) full months prior to the date of application to applicants who: 1. Received medical services in the retroactive period; and 2. Were eligible in the month the medical services were received. Retroactive eligibility will be provided to applicants who were otherwise eligible in the month services were received regardless of whether they were ineligible at other times during the retroactive period. Retroactive eligibility is separate and apart from current eligibility, that is, applicants not eligible for the current period may be eligible for the retroactive period. Retroactive eligibility determinations are required for all categories, except ALF, ARChoices, Autism, DDS Waiver, QMB, and PACE. NOTE:Retroactive coverage for Newborns will not be given prior to the date of birth. NOTE:Beginning May 1, 2018 Adult Expansion Group recipients may be eligible for retroactive coverage thirty (30) days prior to the date of application. Retroactive coverage forthe Adult Expansion Group is date specific. EXAMPLE:James is approved for coverage in the Adult Expansion Group with an application date of September 15. He asks for retroactive coverage for a doctor bill with a service date of August 1. He is not eligible for retroactive coverage because his bill is for August 1 and retroactive coverage can only begin August 16. EXAMPLE:James is approved for coverage in the Adult Expansion Group with an application date of December 31. He asks for retroactive coverage for a doctor bill with a service date of December 1. His regular coverage will begin December 1. As the thirtieth day is included in his regular coverage period, no coverage will be given for the previous month. An application for retroactive eligibility may be made on behalf of deceased persons and eligibility will be provided if they were eligible when the services were received.

For cases in which an applicant has not resided in Arkansas for three (3) full months prior to the date of application, the retroactive period begins with the date the individual established residency in Arkansas. The “previous state” is responsible for the retroactive period prior to the time the applicant established residency in Arkansas. The eligibility worker is responsible for providing the “previous state” with information necessary to determine eligibility for its portion of the retroactive period.