The CAO must determine MA LTC facility services eligibility based on the date of application. An LTC facility resident may be eligible for retroactive MA to cover the cost of medical services incurred while residing in the community or in the LTC facility.
The retroactive period begins the first day of the third calendar month before the application date and ends the day before the application date.
The CAO will use the application date to decide when an individual qualifies for MA LTC. The date of application is either:
the date on which a signed application form is received and date stamped in the CAO.
the earliest date the applicant signs the form if it is submitted by the AAA or other provider.
the date the attending physician certifies a functional need for LTC services, if the individual is receiving MA prior to asking for payment for LTC services.
the date on which an online application is transmitted electronically through COMPASS by the individual.
the date of first treatment or admission if the COMPASS application is submitted by an MA provider.
NOTE: The MA provider must submit the COMPASS application within four calendar months of the date of the first treatment or admission.
If the applicant has unpaid medical expenses incurred during the retroactive period but before admission to the LTC facility, the CAO will determine eligibility for MA as it would for an applicant in the community. The individual does not need to complete a separate Application for Benefits when requesting MA for the retroactive period. The CAO must use the regulations found in the Medical Assistance Handbook to determine retroactive MA eligibility.
NOTE: For NMP, the CAO will not apply the special NMP income limit to determine eligibility for medical services received while the individual was residing in the community.
If the applicant is applying for a MA LTC facility payment for LTC facility services incurred prior to the date of application, the CAO will determine NMP or MNO MA LTC eligibility beginning on the most recent of the following dates:
Date of admission to the LTC facility.
Date of need for LTC facility services payment.
First day of the third month prior to the month of application.
Example: Mr. A is admitted to an LTC facility on March 10. He submits an application on July 10. The LTC facility says he needs payment on April 1. If otherwise eligible, Mr. A can be authorized for MA LTC effective April 1, as this is the most recent of the above three choices.
Updated March 12, 2012, Replacing December 2, 2005