![]() Some people may not become eligible for Medicaid until after they experience a traumatic event, such as a stroke that requires hospitalization and ongoing long-term care needs or a motorcycle accident resulting in a traumatic brain injury. 2 To qualify for retroactive coverage, a Medicaid beneficiary must have been eligible for coverage during the 3 months prior to application when the bill was incurred, and the services must be those that Medicaid covers. Federal law directs state Medicaid programs to cover (and provides federal matching funds for) medical bills incurred up to 3 months prior to a beneficiary’s application date. Retroactive coverage is one of the long-standing safeguards built into the program for low-income Medicaid beneficiaries and their healthcare providers. It also ensures that providers are paid for services they offer to Medicaid-eligible people and helps encourage providers to participate in the program. Medicaid is a safety net program that provides services that private insurance typically does not, such as long-term care, and protects enrollees from unpaid medical bills that they cannot afford. Unlike private insurance, Medicaid covers vulnerable populations, such as seniors, people with disabilities, low-income children and their parents, and other low-income adults. What is Medicaid retroactive coverage and why is it part of Medicaid? This issue brief answers key questions about Medicaid retroactive coverage, describes Iowa’s recent waiver amendment, considers the policy implications of retroactive coverage waivers, and identifies issues to watch. ![]() Retroactive coverage waivers have been approved in a limited number of other states with certain conditions. 1 Populations affected by Iowa’s waiver include low-income parents, children over age 1, Affordable Care Act (ACA) expansion adults, seniors, and people with disabilities. On October 26, 2017, the Centers for Medicare and Medicaid Services (CMS) approved an amendment to Iowa’s Section 1115 demonstration waiver eliminating 3-month retroactive coverage for nearly all new Medicaid applicants as of November 1, 2017.
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