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Title 8: Medicaid Page 30 Iowa Department of Health and Human Services Employees’ Manual Chapter B: Application Processing Determining Eligibility for the Retroactive… Revised October 17, 2025 Retroactive Eligibility for SSI Recipients Retroactive Eligibility for SSI Recipients Legal reference: 441 IAC 76.13(3) and 76.13(3)”d” For an SSI recipient to be eligible for retroactive benefits, they must meet a category of eligibility during the retroactive period as defined in 8-A, Definitions. In addition:  The person must have been eligible for Medicaid benefits in the months services were received (if an application had been filed), and  The person must have paid or unpaid medical bills for Medicaid-covered services received during the retroactive period. The SDX shows unpaid medical claims in the UNPAID RETRO field. A person who is presumptively disabled (disability code P on the SDX) is not entitled to retroactive benefits until a final determination has been made that the person is eligible for disability. Examine retroactive eligibility for an SSI recipient as you would any other applicant. During the retroactive period, the person must have been either:  At least 65 years of age, or  Under 18 years of age, or  Blind, or  Disabled, and  Meet a category of eligibility for the retroactive period as defined in 8-A, Definitions. Accept the member’s statement regarding the date of onset of blindness or disability, unless there is evidence to the contrary. Referrals to CSS Legal reference: 42 CFR 433.145, 441 IAC 75.14(249A) and 75 (Rules in Process) Policy: As a condition of eligibility, Medicaid applicants and members must assign their rights to payments for medical support to the Department unless good cause exists. Child Support Services (CSS) seeks cash medical support as well as financial support for people in the Medicaid eligible group. A child support referral is mandatory in the following situations:  There is an active CSS case;