Page 28

Official source

Title 8: Medicaid Page 26 Iowa Department of Health and Human Services Employees’ Manual Chapter B: Application Processing Effective Date of Eligibility Revised October 17, 2025 Establishing Beginning Months of Eligibility…

Situation: Worker Action: The worker needs to “block” a paid month due to an error in giving conditional eligibility for that month. “Block” the month by entering “B” for that month on the member’s MEPC screen. The system will:  “Back out” the premium payment for the blocked month.  Hold the premium payment as a credit or apply it to another unpaid month.  Issue an alert from WISE requesting recoupment of the paid Medicaid claim for that month. A month is blocked in error. “Unblock” the month on the MEPC by entering a “U” for unblock over the “B” on the month line. Remember, once a month is blocked, the member will not be given Medicaid eligibility for that month until it is unblocked. Comment: See 14-B(9), Change to MEPD Premium: Using MEPC and 8-F, Relationship to Medically Needy. Determining Eligibility for the Retroactive Period Legal reference: 42 CFR 435.914 and 435.915(a), 441 IAC 76.13(3) and 86.5 Medicaid benefits may be available for any or all of the three months before the month in which the application is filed. This time is called the “retroactive period.” The person must meet a category of eligibility for the retroactive period as defined in 8-A, Definitions. EXCEPTION: The following coverage groups do not have retroactive eligibility:  Presumptive Medicaid benefits.  Qualified Medicare Beneficiary (QMB).  Home- and community-based services waivers.  Program for all-inclusive care for the elderly (PACE).

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Page 28

Official source

Title 8: Medicaid Page 26 Iowa Department of Health and Human Services Employees’ Manual Chapter B: Application Processing Effective Date of Eligibility Revised October 17, 2025 Establishing Beginning Months of Eligibility…

Situation: Worker Action: The worker needs to “block” a paid month due to an error in giving conditional eligibility for that month. “Block” the month by entering “B” for that month on the member’s MEPC screen. The system will:  “Back out” the premium payment for the blocked month.  Hold the premium payment as a credit or apply it to another unpaid month.  Issue an alert from WISE requesting recoupment of the paid Medicaid claim for that month. A month is blocked in error. “Unblock” the month on the MEPC by entering a “U” for unblock over the “B” on the month line. Remember, once a month is blocked, the member will not be given Medicaid eligibility for that month until it is unblocked. Comment: See 14-B(9), Change to MEPD Premium: Using MEPC and 8-F, Relationship to Medically Needy. Determining Eligibility for the Retroactive Period Legal reference: 42 CFR 435.914 and 435.915(a), 441 IAC 76.13(3) and 86.5 Medicaid benefits may be available for any or all of the three months before the month in which the application is filed. This time is called the “retroactive period.” The person must meet a category of eligibility for the retroactive period as defined in 8-A, Definitions. EXCEPTION: The following coverage groups do not have retroactive eligibility:  Presumptive Medicaid benefits.  Qualified Medicare Beneficiary (QMB).  Home- and community-based services waivers.  Program for all-inclusive care for the elderly (PACE).