G-7000, Prior Coverage

Revision 21-3; Effective September 1, 2021

A person may be eligible for Medicaid coverage for up to three months prior to the month of application. Prior coverage may be continuous or there may be interrupted periods of eligibility.

A person does not need to be eligible in the month of application (or current month) to be eligible for one or more months of prior Medicaid. The person must meet all financial and non-financial eligibility requirements for the month(s) of requested Medicaid coverage.

To meet eligibility requirements, the person must:

  • be aged, blind or disabled and meet all other non-financial criteria;
  • have resources below the applicable resource limit at 12:01 a.m. on the first day of the month;
  • have income below the applicable income limit; and
  • have received Medicaid-covered services that have not been paid or will be reimbursed by the provider.

Test eligibility separately for each of the prior months and grant eligibility in whole-month increments. Verify the amounts and dates of unpaid or reimbursable services by obtaining a copy of unpaid medical bills or a billing statement from the provider (dated within the last six months).

If eligible for retroactive Medicaid, the person should notify their medical provider and provide a copy of the eligibility notice, so any retroactive claims can be processed appropriately.

Related Policy

Special Income Limits, G-1320
Co-Payment for SSI Cases, H-6000
Medicaid Buy-In (MBI) Income Limits, M-5200