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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 31 14920.4 Retroactive Application Process Requests for retroactive Medicaid are received in various ways as described below: a. Applicants indicate on the application that they have unpaid medical bills in the three months prior to the month of application. b. Many requests are received over the telephone from clients who have an unpaid bill. c. The Medicaid units receive lists from various medical providers such as Division of Public Health, and the school districts requesting assistance with the resolution of an unpaid bill for a Medicaid client. d. The SSI Medicaid Unit receives data from the Social Security Administration via the SDX regarding individuals who need retroactive coverage. 14920.5 Retroactive Eligibility Determination If the individual is determined to be eligible for retroactive coverage, the worker must confirm that the date of service of the individual's medical bill(s) falls within the 3 months prior to the month of application and that the individual meets the financial, technical, and medical (if applicable) eligibility requirements under Medicaid in 1 of the programs eligible for retroactive coverage during the retroactive period. Verify income and resources, as applicable in accordance with DSSM 14800. Obtain information about third party liability information and forward to the TPL Unit. A notice of Retroactive Medicaid Approval or Denial will be used to inform the client of the agency's disposition of the request for retroactive coverage. The client should be aware that even those bills submitted for payment may not be reimbursed by Medicaid (i.e., service not covered by Medicaid, non-participating provider, etc.). 15 DE Reg. 202 (08/01/11) 26 DE Reg. 952 (05/01/23) 28 DE Reg. 387 (11/01/24) 14920.6 Retroactive Eligibility For Newborns A baby born to a woman eligible for and receiving Medicaid on the date of the child's birth is deemed to have filed an application. Also, a mother can apply after a child is born and we will determine her eligibility for 3 month retroactive coverage. If the mother is determined retroactively eligible during her pregnancy or post-partum period, the infant is deemed eligible at birth and remains eligible for 1 year. 13 DE Reg. 1540 (06/01/10) 26 DE Reg. 952 (05/01/23) 14930 Medigap Policies Section 4354 of OBRA 1990 amends Section 1882 of the Social Security Act and imposes statutory limitations on the sale of Medicare supplemental policies (known as Medigap) to Medicare beneficiaries who are also eligible for Medicaid. The provisions apply to policies sold by insurers after 11/5/91 and to individuals who became entitled to Medicaid after that date. It is unlawful for an insurer to sell or issue any health insurance policy (other than an employer group policy) that duplicates Medicare, Medicaid or other health benefits to which the individual is entitled. 14940 Health Insurance Portability And Accountability Act (HIPAA) Certificates The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is intended to guarantee the availability of health insurance coverage for employees and individuals and for limiting the use of preexisting condition restrictions. The law includes portability provisions intended to help ensure health care coverage for employees who move from one job to another. Before this law was passed, changing jobs could result in a temporary loss of comprehensive health coverage during the time it took to meet preexisting condition limitations. HIPAA requires group health plans and health insurance issuers offering group health insurance coverage to reduce any preexisting condition limitation time period by the length of qualifying prior coverage an individual has for that condition.