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Chapter: 2000 Coverage Groups Program: MSSI, SFP 20 1. A request for retroactive Medicaid can be made by the individual or for a deceased individual by a designated representative or caretaker relative, by filing a medical assistance application. 2. In the retroactive period, the individual must have received medical services which would be reimbursable by Medicaid. The individual's statement that he has unpaid medical bills for any of the three months will be accepted; the individual is not required to verify that the bills exist or that the services will be covered by Medicaid. 3. The eligibility specialist will determine eligibility for each of the retroactive month(s) using eligibility criteria for any Medicaid coverage group, regardless of the type of coverage requested by the individual on the application. 4. A determination of eligibility must be made for each of the month(s) in the period. 5. Once current income has been verified and any discrepancies resolved, staff must accept self-attestation that the individual’s income was consistent during the retroactive period. Request additional information only if the income is inconsistent or information known to the agency suggests the individual’s circumstance may have changed in the retroactive period.

All SSI-Related noninstitutionalized applications for retroactive Medicaid due to a disability must have the disability determined by the Division of Disability Determinations (DDD).

For disability cases, the eligibility specialist should call DDD for a Title II diary date and onset date prior to completing the disability forms. If the retroactive Medicaid date is covered by the Title II onset date, then DDD will adopt the decision and completion of the disability forms will not be necessary. (Also see Chapter 1400, Blindness/Disability Determinations.)

All SSI-Related institutionalized applications for retroactive Medicaid (i.e., ICP and HCBS) due to a disability must have the disability determined by the District Medical Review Team (DMRT).

Note: There is no retroactive Medicaid coverage for QMB. For the State Funded Programs (SFP), there is no retroactive coverage. This includes OSS and HCDA. 2040.0812.03 Date of Entitlement for Retroactive Medicaid (MSSI) The period of entitlement for each retroactive month is the calendar month for which eligibility is established; that is, if the individual is determined to be eligible for any day in a month, he is eligible for the full calendar month, except for Medically Needy. Medicaid eligibility in the Medically Needy Program is determined by the day the individual meets their share of cost. 2040.0813.01 Medicaid Designated by SOBRA - MEDS-AD (MSSI) Individuals who are aged and/or disabled may be eligible to receive Medicaid coverage if they meet the SSI technical requirements and have income at or below 88 percent of the poverty level. 2040.0813.02 Financial Requirements for MEDS-AD (MSSI) Any aged or disabled individual may be eligible for Medicaid under this coverage group if the individual has assets equal to or below the Medically Needy asset limit and has income at or below 88 percent of the federal poverty level. 2040.0813.03 Technical Requirements for MEDS-AD (MSSI) The individual must meet all of the following criteria:

1. age or disability, 2. Florida residency, 3. citizenship, 4. welfare enumeration, 5. third party liability, 6. application for other benefits they may be eligible to receive,