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Medicaid Retroactive Coverage Eliminated Effective February 1, 2019

January 28, 2019 in News

Written by Christian Horde, J.D. LL.M.

Starting February 1, 2019, a person who files a Medicaid application will only be able to seek retroactive benefits from the 1st of the month in which the application was filed.

A New Rule Issued by the Agency for Health Care Administration (AHCA) in Florida will eliminate the ability to receive coverage under Medicaid for the 90-day period preceding the month in which the Medicaid Application was filed.

Any January eligibility cases must be applied for before 5 pm on January 31st. Going forward, to secure eligibility in the month of application, all applications must be submitted before 5 pm on the last day of the month. 5:01 pm counts as the next day.

Medicaid applications have a 60-day processing period. Decisions are to be made within the first 30 days. If a case is denied within the first 30 days, the remaining 30 days are available to permit the application to be re-used and provide missing documentation and level of care.

However, all documentation requested by the caseworker for any application must be complete and submitted by the end of the 60th day. No documentation can be submitted after the 60th day or the eligibility will be lost. A new application will be needed for eligibility going-forward with no retro-coverage to the previous months. There is no more application re-use after the 60-day period.

However, if all documentation was submitted in the 60-day period and the case is still pending a level of care, the case should be switched over to Medically Needy by the caseworker. This should hold the place for the original application eligibility date. When the level of care comes in, we were told, the Institutional Care Program (ICP) will be approved back to the original date of the application.

The rules will be applied to all cases, so it is important that re-certifications are done early or on time.

At The Elder Law Center of Kirson & Fuller we can even secure coverage of expenses that were incurred during that 90-day period. Contact us today for more information!


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