Prior Months

Prior Months are defined as any of the following:

the three months prior to the month of a Medicaid application (ABD or Family Medicaid) filed with DFCS

the three months prior to the month of SSI application

DFCS determines eligibility for an SSI intervening Month only if SSI was denied for a financial reason or for a non-financial reason other than failure to meet disability.

Chafee Independence Program Medicaid was authorized as of July 1, 2008. No prior months are available under this COA prior to this date. Former Foster Care Medicaid was authorized as of January 1, 2014. No prior months are available under this COA prior to this date. Parent/Caretaker with Child(ren) Medicaid was authorized as of January 1, 2014. Prior months are available under Low Income Medicaid (LIM) regulations only. Children Under 19 Years of Age Medicaid was authorized as of January 1, 2014. Prior months are available under Right from the Start (RSM) Medicaid regulations only.

Eligibility may be determined for each retroactive/SSI intervening month under any ABD or Family Medicaid Class of Assistance (COA), regardless of the ongoing disposition of the application. See SSI prior month exceptions on page 3.

Potential eligibility for Medicaid for all retroactive/SSI intervening months is protected indefinitely for all Medicaid COAs including SSI. Medicaid can be approved at any time for any retroactive month if all eligibility criteria are met. (See “Prior Months for SSI Applicants” in this section for exceptions for use of SSI COA for SSI applicants).

DFCS does not make a determination on the same prior month(s) more than one time if the initial determination was a financial denial (over income, over resources, etc.) or a basic eligibility denial (citizenship/immigration status/identity, residency, disability, etc.).

For retroactive/SSI intervening months, the following criteria are not required:

enumeration

application for other benefits

cooperation with DCSS

Eligibility may be reconsidered for any month in which the denial was for a procedural reason (i.e. failure to provide verification, lack of information, etc.)

The A/R does not have to be re-interviewed or sign forms that were previously completed for the retroactive/SSI intervening month(s).

Medicaid eligibility is determined only for prior months in which the AU has incurred a Medicaid covered expense that remains unpaid. Verification of the expense is not required.

Services covered by Medicaid and NOT requiring Prior Authorization will be paid for approved retroactive months.

Do not make a DCSS referral if Medicaid is approved for retroactive Medicaid only.

Medicaid may be requested for the three prior months when adding an individual to a case. The day the request to add an individual is made determines the three prior months time period and is the application date for determining the three months prior.