When an application is made for medical assistance, the applicant is automatically entitled to request retroactive medical assistance coverage, for all programs offering retroactive coverage, for a retroactive period prior to their initial application date. An applicant will request retroactive medical assistance coverage if an outstanding or pending medical expense, arising in the retroactive period, exists. Retroactive medical assistance may be requested with an initial medical assistance application or subsequently at a later point in time.
When retroactive eligibility is requested with the initial medical assistance application, it is not necessary for an applicant to have been determined eligible, in the month of application, for prospective medical assistance coverage in order to receive retroactive coverage. When retroactive medical assistance is requested at a date later than an initial application date, the applicant must have been determined eligible for, and have received medical assistance coverage following the initial application. Thus subsequent applications for retroactive eligibility can only be requested for the retroactive periods of existing product deliveries.
It is a prerequisite for retroactive medical assistance that all required evidence has been recorded for the requested retroactive period.