Healthy Horizons eligibility begins at one of the following times: 55 Pa. Code § 140.333
The date the application is date-stamped by the CAO
The date the application is submitted through COMPASS
If it is submitted by a provider, the earliest date the application is signed or the COMPASS date of first admission or treatment.
Healthy Horizons eligibility ends on the date the individual no longer meets the eligibility requirements. The CAO must send the individual appropriate notice before discontinuing benefits. 55 Pa. Code § 140.334
NOTE: The CAO must review eligibility for all other MA categories. If the individual is eligible, the CAO must authorize him or her effective the day following the Healthy Horizons closing.
Retroactive benefits under the Healthy Horizons categorically needy program may be authorized beginning on the first calendar day of the month in which a medical expense was charged. This period may begin no earlier than the first day of the third month before the month of application. 55 Pa. Code § 140.335
NOTE: There are no retroactive benefits under the Healthy Horizons cost-sharing program.
Retroactive Medicare Buy-In for SLMB or QI may be approved for up to three calendar months. The CAO must ask the individual if he or she wants retroactive Medicare Buy-In.
Updated February 14, 2012, Replacing June 3, 2008