Understanding Retro Medicaid

A consumer has questions about applying for retro Medicaid. He asks two different consumer assistance workers questions about his application and receives these responses: The first worker said, “I have made a change on your application and submitted it. Your income for the retro months needs to be verified. You have 30 days to provide this information to complete your application, otherwise it will be closed.” The second worker said, “You have up to a year to apply for retro coverage. However, once you apply for retro coverage, if you fail to provide a document to verify income, your case will be closed and you cannot apply again for retro coverage.”

So, who is correct?

Consumers need to have the retro period requested and the eligibility determined, so the claims can be paid within 12 months.Within the system, they can request retro for a given application for up to 12 months on a change report, but technically they need to begin the request earlier. The first worker gave the correct interpretation of the rule. Once the consumer requests retro on an application, they have 30 days to provide any information requested on a verification checklist (VCL). If the VCL is not satisfied, the case will close after the 30 days. The consumer will need to reapply for coverage and the retro for the initial application will not be available, although a new retro period might be available.

What is an example of this?

A consumer applies on March 3, 2019. Eligibility is established for Medicaid effective March 1, 2019. On May 9, 2019, the consumer requests retro for January 2019. The change report is initiated and the VCL for current monthly income for Jan. 2019 is sent. The consumer does not submit verification of January’s income. On June 8, 2019, the pending application will close for no information. The effective date of the closing will be June 3, 2019. If the consumer reapplies on July 1, 2019, the new retro months available will be April, May, and June 2019. Although, the consumer already has coverage for those months on his initial application. The months of December, January, and February were disposed of with the prior change report that was not verified.

Additional questions about retro Medicaid? Feel free to reach out to heather.forsyth@maryland.gov