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Title 8: Medicaid Page 27 Iowa Department of Health and Human Services Employees’ Manual Chapter B: Application Processing Determining Eligibility for the Retroactive… Revised October 17, 2025

Persons whose citizenship or alien status has not been verified, even though they are eligible during a 90-day reasonable opportunity period, are not eligible for retroactive coverage. For children under age 19 who are eligible without an application under the express- lane eligibility process described at 8-F, Express-Lane Eligibility, the “retroactive period” is any of the three months before the effective date of the child’s express-lane eligibility. To be eligible for retroactive benefits, an applicant must meet both of these conditions:  The applicant has paid or unpaid medical bills for Medicaid-covered services received during the retroactive period, and  The applicant would have been eligible for Medicaid benefits in the months services were received, if a valid application had been filed. An applicant does not need to be eligible in the month of application to be eligible for the retroactive period. If an application is submitted on behalf of a deceased person, determine the deceased person’s retroactive eligibility using the same requirements. When retroactive coverage is requested, evaluate the three months before the month of the current application to see if eligibility exists even if some of those months were denied on a previous application.

1. Ms. A, a pregnant woman, files an application on July 8. She indicates on the application that she wants retroactive benefits. The worker requests in writing that Ms. A provide income verification for the months April through June. Ms. A fails to provide the income information and is denied Medicaid for the retroactive period. The application is approved for ongoing eligibility. 2. Same as Example 1, except that Ms. A is also denied for ongoing benefits due to failure to provide requested information. She reapplies on August 15, and this time cooperates in providing information needed to establish eligibility. She is eligible for the retroactive period of May through July, the three months before the month of the reapplication, and also for ongoing benefits. Determine eligibility for the retroactive period on a month-by-month basis. This includes using a third or fifth paycheck when calculating monthly income. The coverage group under which the person is eligible in the retroactive period may be different for each month. EXCEPTION: See Retroactive Eligibility for Medically Needy Recipients.