The CAO will determine who gets retroactive coverage for MAWD based on the requirements in this section and the following ones:
The CAO must use the following guidelines to determine who is eligible for MAWD and what the monthly premium payment should be:
The MAWD applicant must meet all of the MAWD requirements, including the work requirement for retroactive coverage.
Example: An individual requests three months of retroactive coverage. The individual worked during the first and third months and not the second month. MAWD retroactive coverage is authorized for the first and third months only, because the individual did not meet the work requirement in the second month.
The premium amount for the retroactive coverage is set by using the actual income for the months in which the coverage is asked for. (Section 316.61, Premium Determinations.)
The CAO will let the applicant know that retroactive coverage will not be granted until they pay the premiums due for the retroactive coverage period. The CAO will also let the individual know that the application for retroactive coverage will be held for 30 days. The 30-day count begins on the date the decision on retroactive eligibility is made.
If an individual applies for both retroactive and ongoing benefits, the CAO will not wait to approve ongoing benefits. The CAO will authorize ongoing benefits before receiving the premium for retroactive periods if all proof has been received. Ongoing benefits are effective on the “Eligibility Begin Date” that is entered in CIS/e-CIS.
The CAO will give the individual the initial premium statement and a self-addressed stamped envelope for payment of retroactive premiums. Premiums must be sent to:
Commonwealth of Pennsylvania
Department of Human Services
Medical Assistance for Workers with Disabilities
P.O. Box 8050
Harrisburg PA 17105
NOTE: See Appendix D for information about completing the initial premium statement. The statement must include the individual’s RID.
If payment is not received by the end of the 30-day period, the CAO will reject retroactive coverage, citing nonpayment of the premium.
NOTE: A retroactive Worker with a Disability coverage period must not be considered when determining on eligibility for Worker with a Medically Improved Disability coverage. The retroactive period allows for coverage of medical services. The individual must have had ongoing coverage in the Worker with a Disability group to be eligible for Worker with a Medically Improved Disability coverage.
Updated March 10, 2021, Replacing September 9, 2014