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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 30 Effective January 1, 2024, retroactive medical coverage is potentially available, if general financial and technical eligibility requirements are met, for all Medicaid individuals enrolled under the Diamond State Health Plan (DSHP) and Diamond State Health Plan Plus (DSHP-Plus). Individuals eligible under the Delaware Healthy Children's Program (DHCP) are not eligible for retroactive Medicaid. Individuals in the following programs are excluded from DSHP and DSHP-Plus, but may be found eligible for retroactive Medicaid coverage, if general financial and technical eligibility requirements are met. a. Individuals entitled to the following Medicare Savings Programs i. Specified Low Income Medicare Beneficiaries (SLMB) ii. Qualifying Individuals (QI) iii. Qualified and Disabled Working Individuals (QDWI) b. Individuals residing in an intermediate care facility for individuals with intellectual disabilities (ICF/IID) or for individuals with mental disease (ICF/IMD) c. Individuals in need of only the 30-Day Acute Care Hospital Program d. Individuals eligible under the Breast and Cervical Cancer Treatment Group. e. Individuals eligible for emergency, labor, and delivery coverage only. f. Incarcerated Medicaid members. All other individuals in programs excluded from DSHP and DSHP-Plus are not eligible for retroactive Medicaid Coverage. These include, but may not be limited to, individuals enrolled in the following programs: a. The following Medicare Savings Program - Qualified Medicare Beneficiary. b. The Chronic Renal Disease Program. c. The Delaware Prescription Assistance Program. d. The Delaware Cancer Treatment Program. e. The Part C Program. f. The VFC Immunization Program. 15 DE Reg. 1716 (06/01/12) 26 DE Reg. 952 (05/01/23) 28 DE Reg. 387 (11/01/24) See 14920.1 Retroactive Coverage Limitations - History 14920.2 Retroactive Coverage Of Medical Bills Individuals or families who apply for Medicaid and who may be eligible for Diamond State Health Plan or the Diamond State Health Plan Plus may be eligible for retroactive Medicaid coverage of any unpaid medical bills incurred in any of the three months prior to the month in which they applied. However, certain requirements must be met in order for these bills to be paid under Medicaid. a. The client must have been eligible in all respects for Medicaid in one of the retroactive eligibility categories in the month(s) that the medical services were received (including Delaware residency). b. The medical bill must be for a service covered by Medicaid. c. The client did not have any third party coverage that would have been responsible for paying the bill. d. The medical service must have been given by a provider who was a participant in the Delaware Medicaid program at the time of service. If the provider was not enrolled at the time of the service, the provider may enroll retroactively (up to 12 months). 26 DE Reg. 952 (05/01/23) 14920.3 Retroactive Coverage Time Limits There is no time limitation on requests for retroactive coverage. They may be processed at any time. 26 DE Reg. 952 (05/01/23)