An individual may receive up to 3 months Retroactive coverage once determined eligible for a Medical Assistance with Spend Down and once they have met the Spend Down amount for the budget period. The individual can receive a maximum of 3 months retroactive coverage. This covers the three-month period directly prior to the date of application for the Medical Assistance program.
Individuals can also apply for retroactive coverage when there has been a break in program coverage of 30 days or more and they have not received coverage under any other coverage type (except Cost Sharing) during that period. Retroactive coverage will only be given on a month by month basis during this period up to a maximum of 3 months. Each month within the retroactive period is treated as a separate Spend Down period. Individuals must meet both the coverage type eligibility requirements and the Spend Down amounts in each individual month in order to receive retroactive coverage for that month.
The caseworker can trigger the system to check for retroactive eligibility on application or post application. If checking post application the caseworker must select the retroactive period they require eligibility to be determined for retroactively. The caseworker is presented with eligibility results from which the caseworker can select to authorize, decline or deny. If the case worker selects to authorize an eligible result for a household member(s) eligible or Medical Assistance with Spend Down, the system will either create a new Spend Down product delivery or reuse an existing one. If the household member(s) has an existing Spend Down product delivery of the same type on the current integrated case, the system will update the existing Spend Down product delivery with the retroactive Spend Down periods.