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Title 8: Medicaid Page 29 Iowa Department of Health and Human Services Employees’ Manual Chapter B: Application Processing Determining Eligibility for the Retroactive… Revised October 17, 2025 Verification Requirements Clearly document in the case record how eligibility or ineligibility for each month was established. Information to be documented includes:  Verification of income and resources.  Household composition for each month.  Beginning date of disability, if applicable. Retroactive Eligibility for Medically Needy Recipients Legal reference: 441 IAC 75 (Rules in Process) and 76.13(3) A Medically Needy certification period is considered as one unit. Even though the period may include one or more months, determine eligibility for the entire certification period only. The retroactive period for Medically Needy is a one-month, two-month, or three-month period, depending on which month the client first incurred a medical expense. See 8-J.

1. Ms. S, a pregnant woman, applies for Medically Needy on March 5. The certification period is March and April. Ms. S claims to have unpaid bills for December and January, which are within the three-month retroactive period. The worker requests income and resource information for all three months of the retroactive period (December - February). If income or resource verification is not provided for December through February, eligibility for the retroactive period cannot be determined. 2. Ms. B, a pregnant woman, applies for Medically Needy on April 15. The certification period will be April and May. She states that there are no unpaid medical bills for the retroactive period (January - March). In June, Ms. B reports that there is an unpaid medical bill for January. The worker establishes eligibility for the three-month retroactive period. Income from all three months is used in computing spenddown. Spenddown for the retroactive period is $100. The unpaid bill is $500. The amount in excess of the spenddown ($400) is Medicaid-payable in the retroactive period.