Retroactive Months

Follow the steps below to determine retroactive Medicaid Eligibility.

Step 1 For Family Medicaid, determine the AU and BG for each month requested. Refer to Chapter 2600, Assistance Units, for Family Medicaid. For ABD Medicaid, determine financial responsibility for each month. Refer to 2500 ABD Financial Responsibility and Budgeting Overview . An interview is not required. Additional required information may be obtained by telephone or by mail. Contact the A/R or personal representative (PR) acting on his/her behalf. A PR may provide information for a deceased A/R. This person should be knowledgeable about the A/R’s circumstances Step 2 Determine for which month(s) retroactive Medicaid is being requested and establish a class of assistance (COA) for each month. Refer to Chapter 2100, Medicaid Classes of Assistance. Step 3 Establish basic eligibility criteria for each month. Refer to Chapter 2200, Basic Eligibility Criteria. If the A/R applies for prior months as a disabled individual, disability must be verified for each prior month. Refer to 2205 Aged, Blind, Disabled Requirement for ABD Medicaid . Step 4 Determine financial eligibility for each month. Refer to Chapters 2500, ABD Financial Responsibility and Budgeting and 2650, Family Medicaid Budgeting. Use actual income and expenses for prior months. Use anticipated income and expenses for intervening months or actual income if available. For Family Medicaid COAs, if multiple, non-financial changes occurred in a retroactive month, use the circumstances on any day of the month that is most advantageous to the AU in determining eligibility. Step 5 Budget each prior month separately using the budgeting procedures for the COA chosen for that month. Step 6 Approve Medicaid under the appropriate COA if the A/R meets all eligibility criteria. Deny any ineligible months. If any AU members are ineligible, complete a CMD to consider Medicaid eligibility under all other COAs. Refer to 2052 Continuing Medicaid Determination . Step 7 Notify the AU. For MN cases, include the Begin Authorization Date (BAD) and spenddown information, if required. Step 8 Complete a Form 962 only if the retroactive month(s) cannot be transmitted electronically (i.e. more than 13 in the past and cannot be entered on GA Gateway). If Form 962 is necessary, annotate Form 962, “Please enter manually, cannot transmit via GA Gateway”. Forward Form 962 to the Gainwell Technologies Contact Center and upload a copy of the form with fax transmission report through Document Management in GA Gateway. Refer to Appendix C for the Member Contact Center mailing address.