Retroactive Medical

Created on: 
Sep 12 2017

See ACES Screens and Online pages for an example of pages or screens used in this chapter.

Who is eligible for retroactive medical?

Clients who are eligible for certain medical programs may be eligible for retroactive medical. For more information, see:

How long is the retroactive medical certification period?

Retroactive medical can be approved for up to three months prior to the application month. For more information, see:

When can retroactive medical be requested for Modified Adjusted Gross Income (MAGI) Assistance Units (AUs)?

Retroactive medical can be approved for MAGI AUs (N-Track) up to three months prior to an Application Date of October 2013, except for MAGI - New Adult (N05) and MAGI - New Adult Alien Emergency (N25) medical AUs. Retroactive medical on N05 and N25 AUs can only be approved back to January 2014.

Online Processing

How do I initiate retroactive medical?

This function does not currently exist for online processing. For more information, see Mainframe Processing - How do I initiate retroactive medical?

How do I process retroactive medical benefit months?

Processing Alternative: No Spenddown segment created when some months are approved / denied in ACES, also rejects in ProviderOne (PR 322946)

To process a retroactive Medicaid application, take the following steps:

  1. On the Case Actions page, select one of the retroactive months from the Benefit Month drop down menu and click Start Changes.
  2. Review and update case information as needed and commit the changes.
Note: For any month the client won't receive retroactive medical, deny the month by entering [a 500 level reason code] in the Reasons field on the AU Details page. For more information, see How do I deny a pending Assistance Unit (AU) or client in some months?
  1. Repeat steps one and two for the remaining months.

How do I finalize retroactive medical benefits?

This function does not currently exist for online processing. For more information, see Mainframe Processing - How do I finalize retroactive medical benefits?

How do I authorize retroactive medical benefits when the Retro Medicaid Copy function isn’t available for the Assistance Unit (AU) I am working on?

The user must screen in a new AU with a three month spenddown base period to cover the retroactive medical months. For more information, see How do I setup a retroactive spenddown base period?

How is retroactive medical determined in ACES for Modified Adjusted Gross Income (MAGI) Assistance Units (AUs)?

This function does not currently exist for online processing. For more information, see Mainframe Processing - How is retroactive medical determined in ACES for Modified Adjusted Gross Income (MAGI) Assistance Units (AUs)?

What reason codes are used to deny retroactive Modified Adjusted Gross Income (MAGI) benefit months?

The following reason codes are allowed to deny retroactive MAGI benefit months:

  • 201 - Living Arrangement - Cash/Medical Assistance
  • 202 - Citizenship/Alien Status
  • 210 - Failed Residency Requirement
  • 220 - Failed Age Requirement - Medical
  • 301 - Exceeds Income Standard
  • 503 - Acceptable Medical Source (and no medical)
  • 504 - Insufficient Information
  • 520 - Change in Federal Law
  • 528 - Eligibility Review Form Incomplete
  • 550 - Voluntary Withdrawal
  • 551 - Whereabouts Unknown
  • 552 - Failed to Provide Verification
  • 559 - Client Already Received Assistance in Another AU For This Benefit Month
  • 561 - Screened in Error - For Administrative Use Only
  • 566 - Refused to Cooperate with the Application Process
  • 577 - Missed Application Deadline - For Administrative Use Only
  • 587 - Already Eligible for Program in Different AU - For Administrative Use Only
  • 588 - Ineligible QI-1 Already Receiving MA
  • 599 - Other - For user Generation Only

How do I initiate and process Modified Adjusted Gross Income (MAGI) retroactive medical?

This function does not currently exist for online processing. For more information, see Mainframe Processing - How do I initiate and process Modified Adjusted Gross Income (MAGI) retroactive medical?

Mainframe Processing

How do I initiate retroactive medical?

To initiate retroactive medical, take the following steps:

  1. On the AMEN screen, complete the following fields:
  • Selection field - Enter [W] - Retro Medicaid Copy.
  • AU ID field - Enter the [Assistance Unit ID] and <TRANSMIT>.
  1. On the RMCO screen, enter [Y] - Yes in the Continue field and <TRANSMIT>.

How do I process retroactive medical benefit months?

This function no longer exists for Mainframe processing. For more information, see Online Processing - How do I process retroactive medical benefit months?

How do I finalize retroactive medical benefits?

To finalize retroactive medical benefits, take the following steps:

  1. On the AMEN screen, select Option [X] - Finalize RETRO Medicaid.
  2. <TRANSMIT> and the FRME screen displays.
  3. <TRANSMIT> again and the ELIG screen displays.
  4. Confirm eligibility for all benefit months and finalize.

How do I authorize retroactive medical benefits when the Retro Medicaid Copy function isn’t available for the Assistance Unit (AU) I am working on?

The user must screen in a new AU with a three month spenddown base period to cover the retroactive medical months. For more information, see How do I set up a retroactive spenddown base period?

How is retroactive medical determined in ACES for Modified Adjusted Gross Income (MAGI) Assistance Units (AUs)?

Retroactive medical eligibility for MAGI medical must be determined offline by the user before finalizing the retroactive medical as ACES does not determine eligibility for these months.

Users have specific reason codes available to deny retro medical on the RMCO screen for months the client is not eligible. MAGI AUs are approved for benefit months with no reason code entered.

No letters generate for MAGI AUs and ACES does not modify a MAGI AU in any way, other than to set the AU status, client status and financial responsibility code. Health Care Authority (HCA) eligibility staff must manually generate the necessary approval and denial letters from the Healthplanfinder system as needed.

What reason codes are used to deny retroactive Modified Adjusted Gross Income (MAGI) benefit months?

When any particular month in the retroactive period needs to be denied, enter one of the following 500-level reason codes on the RMCO screen to deny that particular month:

  • 201 - Living Arrangement - Cash/Medical Assistance
  • 202 - Citizenship/Alien Status
  • 210 - Failed Residency Requirement
  • 220 - Failed Age Requirement - Medical
  • 301 - Exceeds Income Standard
  • 503 - Acceptable Medical Source (and no medical)
  • 504 - Insufficient Information
  • 520 - Change in Federal Law
  • 528 - Eligibility Review Form Incomplete
  • 550 - Voluntary Withdrawal
  • 551 - Whereabouts Unknown
  • 552 - Failed to Provide Verification
  • 559 - Client Already Received Assistance in Another AU For This Benefit Month
  • 561 - Screened in Error - For Administrative Use Only
  • 566 - Refused to Cooperate with the Application Process
  • 577 - Missed Application Deadline - For Administrative Use Only
  • 587 - Already Eligible for Program in Different AU - For Administrative Use Only
  • 588 - Ineligible QI-1 Already Receiving MA
  • 599 - Other - For user Generation Only

How do I initiate and process Modified Adjusted Gross Income (MAGI) retroactive medical?

To initiate and process MAGI retroactive medical, take the following steps:

  1. On the AMEN screen, complete the following fields:
  • Selection field - Enter [W] - Retro Medicaid Copy.
  • AU ID field - Enter the [Assistance Unit ID] and <TRANSMIT>.
  1. On the RMCO screen, complete the following:
  1. <TRANSMIT> and the AMEN screen displays.

 

See ACES Screens and Online pages for an example of pages or screens used in this chapter.