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MAY 3, 2018 NEBRASKA HEALTH AND MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HUMAN SERVICES MANUAL 477-000-017

477-000-017-- Retroactive Medicaid

Retroactive Medicaid Retroactive Medicaid may be requested within six months of the initial application, even if there was no indication of a retro need on the initial application. Retroactive Medicaid requested on the initial application that was not acted on by the agency will be addressed despite the date the Retroactive Medicaid was initially requested. Example 1 Jan applied for Medicaid on 1/15/2017. On her application she marked No to the question that asks, “Do you want help paying for medical bills from the last 3 months”? Jan did not indicate anywhere on the application that she needed Medicaid for October, November and/or December 2016. Jan calls the Customer Service Center on 4/03/2017 and requests a Retroactive Medicaid eligibility determination for October, November and December 2016. Can we process Jan’s request? Answer: YES. Jan requested the Retroactive Medicaid eligibility determination within six months from the application date. Example 2: Same scenario as example 1; however, Jan sends a letter to DHHS on 8/30/2017 and requests that we look at her eligibility for Retroactive Medicaid for October, November and/or December 2016. Can we process Jan’s request? Answer: No. Jan requested Retroactive Medicaid more than six months after her application was received AND Retroactive Medicaid was never requested on her initial application. Example 3 Jeffrey applied for Medicaid on 2/1/2017. On his application he marked Yes to the question that asks, “Do you want help paying for medical bills from the last 3 months”? Retroactive Medicaid was not processed at initial application. Jeffrey calls the Customer Service Center on 6/30/2017 and asks to have Retroactive Medicaid eligibility determined for November, December 2016 and January 2017. Can Jeffrey’s request be processed? Answer: Yes. Jeffrey requested Retroactive Medicaid on his initial application. His Retroactive Medicaid request needs to be processed despite the date that it was initially requested.