16 Del. Admin. Code §§ 20000-20370

Current through Register Vol. 27, No. 11, May 1, 2024

Section 20000-20370 - LTC Retroactivity

Any individual or couple who applied for Medicaid may also be eligible for Medicaid coverage of any unpaid medical bills incurred in any of the three months prior to the month in which they applied. However, certain requirements must be met in order for these bills to be paid under Medicaid.

Applications for Medicaid, even if denied, qualify for a determination of retroactive eligibility.

a) Individual must document that for time period in which bill was incurred, all medical and financial conditions of the Long Term Care Program have been met. For individuals whose income is between the SSI standard and 250% of the SSI standard, retroactive payment is only possible if the individual has been institutionalized 30 consecutive days. The assumption used for initial nursing facility eligibility determination, that the applicant will remain institutionalized for 30 consecutive days, does not apply for retroactive coverage when it is obvious the 30 day criteria has not been met.

b) Individual must supply documentation of the unpaid bill. In some circumstances, bills may have been paid by someone other than the applicant and they have requested a refund. Documentation of provider reimbursement and unpaid balance must be provided. Acceptable documentation would be a copy of the provider reimbursement check written to someone other than the applicant. Credit to a patient's account is not acceptable. If part of the 30 day consecutive period was hospitalization no documentation of unpaid hospital bills are required.

16 Del. Admin. Code §§ 20000-20370