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Title 8: Medicaid Page 28 Iowa Department of Health and Human Services Employees’ Manual Chapter B: Application Processing Determining Eligibility for the Retroactive… Revised October 17, 2025 Verification Requirements If the self-attested income that the household reported verifies with electronic data sources or is cohort approved and results in ongoing eligibility, this amount can be used to determine retroactive eligibility. If the self-attested income does not verify with electronic data sources, the worker will need verification of actual income to determine eligibility for the retroactive period. Issue a notice of decision when retroactive eligibility is denied. When approving an application for retroactive Medicaid only, include the month when eligibility ended on either the Notice of Decision approving the retroactive months or on a separate notice. The notice does not need to be timely when assistance is simultaneously approved and ended for retroactive eligibility. A member who did not know that there were bills in the retroactive period at the time of application can ask to have eligibility for retroactive benefits determined at a later date. The retroactive period is the three months before the month of the most recently approved and active Medicaid application. Retroactive eligibility cannot be determined later on an application that was denied or canceled for ongoing benefits. Also, a person may request retroactive coverage but may fail to provide the information needed to determine eligibility. Even though a notice of decision was issued, the member may request to have eligibility determined again for the same retroactive period if the application was approved for ongoing benefits and it remains the most recently approved Medicaid application. Although a member may request retroactive benefits at any time, payment will not be authorized for services provided 23 months or more before the current month unless extenuating circumstances exist. See 8-M, Submitting Claims for more information. Benefits can be approved for SSI approvals beyond the two years by submitting special updates when the SSI eligibility determination went beyond the two years. Verification Requirements When determining retroactive eligibility, accept a client’s statement that the client has paid or unpaid medical bills (unless questionable). See 8-F, Continuous Eligibility for Pregnant and Postpartum Women for requirements when establishing continuous eligibility for pregnant women at the time of application.