Retroactive Medicaid Eligibility at Risk

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What is it?

Retroactive Medicaid Eligibility (RME) is a policy under current law that allows Medicaid applicants to be retroactively covered not only from the date the application was submitted, but also three months prior to the application. This coverage is only available in those months when the person would otherwise have met all Medicaid eligibility requirements, such as income and asset limits.

Why is it important?

The Florida Policy Institute gave a great example of how this policy can help thousands of people, and why it would be detrimental if the policy was to be ended.

“A mother gave birth to a premature infant, requiring two months of hospitalization. The mother applied for children’s Medicaid the month following the child’s birth, including a request for retroactive coverage, but the state failed to act on the request. In the meantime, the family was facing thousands of dollars of hospital bills. After a legal aid lawyer successfully helped the family challenge the state’s failure to process the application for retroactive Medicaid, the first month of the infant’s hospital stay was covered.”

This retroactivity is important because there can be serious barriers to applying for Medicaid. Once someone learns that they are eligible for Medicaid, navigating the application process is extremely complex and time-consuming. Because the person eligible for Medicaid is typically very ill, the responsibility of applying often falls on a family member or caretaker whose immediate attention is ensuring that their loved one’s medical condition is stabilized before figuring out how to pay for it. In the meantime, large medical bills can pile up, putting families at risk for enormous medical debt and bankruptcy.

Why is it at risk?

The Florida 2018-2019 budget requested that the Florida Agency for Health Care Administration seek federal approval to “eliminate the Medicaid retroactive eligibility period for non-pregnant adults.” This means that the Medicaid applicant would be eligible the first day of the month that the application was submitted. If the RME was eliminated, there would be detrimental effects on the elderly and disabled adults. For instance, nursing homes may require the applicant to pay the expensive private pay rate until Medicaid approves the application, which could take months. The decision has not yet been made on eliminating RME, but Medicaid applicants, medical professionals, and elder law advocates are hoping that the policy is here to stay.



Florida Policy Institute:

“The end of Medicaid retroactive eligibility?”. Heidi M. Brown. The Elder Law Advocate. Vol, NO. 2. Summer 2018.

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