19-02 Version of 2.8 Begin Dates

2.8.1 Begin Dates Introduction
2.8.2 Backdated Eligibility

2.8.1 Begin Dates Introduction

Medicaid eligibility begins the first day of the month in which the valid application is submitted and all program requirements are met with the following exceptions. Those begin dates are the date a valid application is submitted, all program requirements are met, and:

Deductible – The date the deductible was met.
Inmates – The date the memberA recipient of Medicaid; formerly referred to as a "client." is no longer an inmate of a Public InstitutionA public institution is an institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. The term“public institution” does not include a medical institution (5.8.1), a publicly operated community residence that serves no more than 16 residents, or a child care institution which foster care maintenance payments are made under Title IV-E..
Person Adds – The date the person moved into the household.

Recent Moves – The date the member moved to Wisconsin.
Exception: The begin date for an SSISupplemental Security Income. A program based on financial need operated by the Social Security Administration that provides monthly income to low income people who are age 65 or older, blind, or disabled. recipient who moves to Wisconsin is the 1st of the month of the move.

Example 1:

SSI recipient Mr. Nebble moves to Wisconsin from Vermont in April 2009. He becomes eligible 04-01-09 in Wisconsin.

Home and Community-Based Waivers – The program start date provided by the care manager.
Family Care and PACEProgram of All-Inclusive Care for the Elderly or Partnership – The date the individual is enrolled in the MCOManaged Care Organization.
Institutionalized – His or her entry into the nursing home or hospital.
QMBQualified Medicare Beneficiary – The first of the month following the eligibility confirmation.
SeniorCare – The first of the month following the month in which all program requirements have been met.

2.8.2 Backdated Eligibility

Medicaid eligibility can be backdated up to three months prior to the month of application.

The backdated eligibility should not go back further than the first of the month, three months prior to the application month. The member may be certified for any backdate month in which he or she would have been eligible had he or she applied in that month.

A backdate request can be made at any time except when the member is already enrolled and backdating the member’s eligibility would result in a deductible for the backdated period.

If a member has incurred a bill from a Medicaid-certified provider during a backdate period, instruct the member to contact the provider to inform them to bill Medicaid. The member may be eligible to receive a refund, up to the amount already paid to the provider.

Example 2:

Mary who is 66 years old, applied for Medicaid on April 6, and was found eligible. At the time of application, Mary did not request a backdate.

In September Mary is billed for a doctor’s appointment she had at the end of February. Mary can ask to have her eligibility backdated through February. She meets all non-financial and financial eligibility criteria in the months of February and March. Her worker certifies her for Medicaid for both months.

See Section 15.6.8 Backdated Months for information on counting self-employment income for backdated months.

For backdating rules for Medicare Beneficiaries, see Section 32.8 Medicare Savings Programs Backdating.

Assets

A person’s asset eligibility in a backdate month is determined by whether or not he or she had excess assets on the last day of the month. If he or she had excess assets on the last day of the month, he or she is ineligible for the entire month. If he or she was asset eligible on the last day of the month, he or she is eligible for the whole month.

This page last updated in Release Number: 19-02
Release Date: 9/10/2019
Effective Date: 6/22/2019