Retroactive Medicaid Coverage

Medicaid is one of the governmental programs that provide medical and health-related services to US citizens, along with Medicare.  It is run by the Centers for Medicare and Medicaid Services, a division of the United States Department of Health and Human Services.  This is mainly targeted for low-income families and you must be eligible for the program in order to avail of its services.  For those who have no private health insurance coverage this is an option, especially for those who cannot afford them.  The federal government oversees Medicaid, but each state can come up with their own rules regarding eligibility, scope of services, rates, and programs.

Some citizens still do not avail of Medicaid, maybe because they do not have enough information to be able to do so.  Worse, they only apply for this benefit if they are already under dire circumstances.  But there is good news, especially for those people who have spent out of their own pockets for their illness.  If you do not have insurance coverage prior to enrolling in Medicaid, you may still be able to qualify for what they call as retroactive Medicaid coverage.  This means that you are still entitled, or may receive Medicaid coverage for up to three months prior your application.  However, certain limits have also been placed on this coverage.  You must meet the financial qualifications of Medicaid during the past three months that you are going to retroactively charge Medicaid for.  In addition, the type of care that you received must also be qualified, and that type of care was what you needed during those months.  You should also remember that the health services that you had availed of are those covered by Medicaid.  If these treatments are ruled to be out of scope, then you will still be responsible for those bills.  You also need to do some research at this point, because when you are still in the application process, Medicaid will only pay for services directly to your health provider.  They will not reimburse you for any out of pocket expenses that you have made.  It is always wise to look for a health provider who will agree to bill Medicaid at a later time, instead of you having to shell out cash for the treatment that you will be getting.

How do you apply for retroactive Medicaid coverage?

  1. You should obtain an application form from Medicaid.  In order to do this online, you can type Medicaid then the name of your state, so that it will direct you to the specific site dedicated to your state.  You can download an application form from there.  Otherwise, you can also obtain it from hospitals.
  2. Fill out all the required information in the application form.  If you have dependents over 18, they should be the one to submit their Medicaid application themselves.
  3. Submit these forms in person.  Although face-to-face interviews are not required by most states, we would advise that you hand over your application personally.  Do not send your form by mail, as you would need to present the original copies of some documents.  Should you have questions, contact your Medicaid office.
  4. Remember to write down or block appointments with your Medicaid office.  Failure to show up or provide documentation will only delay your application.