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100 (07/2026) Chapter 2:Eligibility • Section 1: Application from the correctional facility or the date the individual begins a period of hospitalization outside of the correctional facility. Retroactive medical benefits If a benefit group requests and is eligible for retroactive medical benefits and has a Medicaid-covered cost prior to the month in which the date of request falls, the earliest date they can be eligible is the first day of the month that is three months before the date of request. For example, if the benefit group requests benefits on July 10th, eligibility may begin as early as April 1. If an individual is deceased and a person acting on their behalf completes an application for them, that person may be eligible for retroactive medical. After establishing the earliest date, determine eligibility on a month-by-month basis. The period starts on the earliest established date and ends on the date the benefit group requests benefits. For example, if the benefit group requests benefits on August 10th, the earliest effective date is May 1. Establish eligibility separately for May, June and July. Renewal of benefits The effective date for continuing eligibility at the end of the eligibility period is one of the following: • If the renewal form is received before the end of the last month of the eligibility period, the effective date for an eligible benefit group is the first day of the month after the renewal period. • If the renewal form is not received before the end of the individual’s last month of eligibility, end benefits unless the filing group has contacted ODHS|OHA before the end of the last month of the eligibility period AND completed the renewal within the month following the last month of the eligibility period. If the renewal form is received later, determine the effective date as if it were a new application. When a renewal is initiated, the filing group must be reviewed for other medical program eligibility prior to reducing or ending medical benefits. If additional information is needed to redetermine eligibility, the benefit group remains eligible from the date the review is initiated until ODHS|OHA determines eligibility in accordance with the application processing time frames. Restored benefits The effective date for restoring benefits that were underpaid (including erroneous collections of overpayments) or denied or closed in error is one of the following: • If the error resulted from ODHS|OHA error, use the date the error was made. Restore benefits only for the preceding 12 months. • If the error resulted from participant error, use the earliest of the following:
The first day of the month the benefit group notifies the branch office of the possible loss.
The month the branch office discovers the loss.
The date a hearing is requested.