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99 (07/2026) Chapter 2:Eligibility • Section 1: Application B Medicare premiums, the earliest date they can be eligible is three months before the original date of request. This means that there can potentially be a gap in coverage. For example, if the DOR is 9/30 and the effective date of SMB is 10/1 (verification of income was needed and not received until 10/5), then the retroactive benefits cover June, July, and August (no benefits in September). An individual may be eligible in ANY one or ALL of the three months. To receive benefits, an individual must meet ALL eligibility factors for SMB or SMF. Individuals are eligible for retroactive SMB and SMF even if they were not actually enrolled in Part B; however, if that is the case, they must be eligible to enroll and must have incurred Medicare Part B covered services in those months. The person can be enrolled in Part B retroactively and SMB and SMF will pay the premium if the individual is eligible for SMB or SMF in each of the retroactive month(s). This includes deceased individuals who would have been eligible for Medicaid-covered premiums if a person acting on their behalf completes an application for them. Note: Individuals are not eligible for retroactive SMF in any month they were receiving OSIPM or HSD medical programs.

Continuous eligibility (CE) CE Periods are established once all Requests for Information (RFIs) are cleared at intake, renewal, or when an individual is moving from a program ineligible for CE to a program eligible for CE. OSIPM Initial month The initial month includes: • When an individual is newly applying for medical, and • When an individual is currently receiving medical and is determined eligible for a better program (for example, receiving MSP and becomes eligible for OSIPM). The effective date for starting medical benefits for OSIPM is one of the following, whichever occurs first: • If the applicant meets all eligibility requirements on the date of request, the effective date is the first of the month in which the date of request was established. • If all eligibility requirements are not met in the month containing the date of request but are met within 45 days of the DOR, the effective date will be the first day of the month the requirements are met. • If the 45-day processing period has been extended due to delays beyond the applicant’s control, the effective date will still be the first of the month in which the individual established a date of request (if eligible). If not eligible on the date of request or on any day in the same month, the effective date will be the first day of the month in which the requirements are met. In other words, if an extension was granted, the applicant does not have to establish a new DOR. Incarcerated individuals If an individual has been released from a correctional institution and is determine eligible for OSIPM, the effective date for beginning the individual’s medical assistance is the date the individual is released