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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 January 2021 Subchapter Subject Page ending with Page M0130 APPLICATION PROCESSING M0130.100 4

If action is not taken within the time standard, the case record must show the cause for the delay and the applicant must be notified in writing of the status of his application, the reason for the delay, and his right of appeal. When an application is delayed after 90 days because of a disability decision and the agency has determined that excess resources exist at the time the delay notice is sent, the NOA must inform the applicant that he/she has excess resources and the amount. The notice must also state that: • a final action cannot be taken until the disability decision is made; • if the applicant is determined to be disabled, he/she will not be eligible unless the excess resources are reduced; and • he will be notified when the disability decision is made. B. Application for Retroactive Coverage The retroactive period is based on the month in which the application is filed with the agency. The retroactive period is the three months prior to the application month. Retroactive Medicaid eligibility must be determined when an applicant for medical assistance indicates on the application that he, or anyone for whom he requests assistance, received a covered medical service within the retroactive period. The covered service may be listed by the applicant as an actual medical service on the application, or information on the application may indicate that a service was received, such as the birth of a child or Medicare coverage during the retroactive period. An individual may request retroactive coverage at any time subsequent to an application even if the application was denied or the applicant signed a statement saying he did not want retroactive coverage. The retroactive period is based on the application month regardless of whether the application was denied or approved. There is no administrative finality on determining retroactive eligibility if eligibility for the months in the retroactive period has not been determined. If the application was denied, the application is reopened for determination of eligibility in the entire retroactive period – all three months prior to the application month – even if a covered medical service was received in only one retroactive month. The applicant must provide all verifications necessary to determine eligibility during the retroactive period. If the applicant is found eligible for retroactive coverage and a Medicaid-covered medical service was received over one year prior to the date the retroactive eligibility is determined, the applicant must be given an "Eligibility Delay" letter to give to the medical provider so that Medicaid will pay the claim (see the sample letter on the intranet at https://fusion.dss.virginia.gov/bp/BP- Home/Medical-Assistance/Forms. Once retroactive eligibility is established, Medicaid coverage begins the first day of the earliest retroactive month in which retroactive eligibility exists.