400.03.02 RETROACTIVE MEDICAID FOR ABD APPLICANTS USING MAGI RULES

A request for ABD Retroactive Medicaid is part of the ABD Medicaid application form. An individual does not have to be eligible for Medicaid ongoing (or for SSI ongoing) in order to have Medicaid eligibility determined for the retroactive period. If a request for ABD retro or SSI retro is made, determine potential retroactive Medicaid using the most appropriate ABD COE (with the exception of QMB-only). If eligibility for retroactive SSI or ABD Medicaid fails, it is permissible to place an individual requesting retroactive Medicaid (SSI retro or other ABD retro requests, other than QMB-only) in a MAGI-related COE for the retro period. The individual must meet all MAGI-related eligibility criteria, and all required verifications must be obtained. Additional information must be secured by the Specialist, such as tax filing status, household relationships, household income, etc. MAGI eligibility should only be evaluated when ABD eligibility fails for the retroactive period and the possibility of MAGI-related eligibility exists, i.e., the applicant is under age 19 or is a parent/caretaker with very low income. A MAGI application may indicate possible ABD eligibility, as discussed in Chapter 101, Section 101.09, Combination MAGI and ABD Applications. Retroactive Medicaid would be part of the MAGI to ABD application, using ABD rules if MAGI eligibility is not possible for the applicant. For MAGI applicants with no indication of possible ABD eligibility, use MAGI rules to determine retroactive Medicaid.