Iowa Medicaid change ends retroactive benefits

A recent change to Medicaid in Iowa will affect how patients apply for the program and eliminates retroactive Medicaid payments to health care providers.

Medicaid previously had a provision that allowed for payments for health care services that were delivered in the three months prior to a person being approved for Medicaid coverage. In August, the Iowa Department of Human Services asked the federal Centers for Medicare and Medicaid Services (CMS) to eliminate this retroactive eligibility for Medicaid applicants. CMS recently approved the state’s request to eliminate the three-month retroactive eligibility period for most patients.

Beginning Nov. 1, most patients applying for Medicaid must do so by the last business day of the same month they received care in order for Medicaid to consider paying for their charges.

The effective date of Medicaid coverage now begins on the first of the month in which the application is received—except for pregnant women and children younger than 1 year old. Pregnant women and children under age 1 will continue to be eligible for three months of retroactive coverage. Pregnant women also will be eligible for retro coverage for the 60-day period that begins on their last day of pregnancy.

Following is an at-a-glance chart showing the new Medicaid application guidelines:

Type of patient who does not have insurance Timetable to apply for Medicaid
Most patients The last business day of the same month they received care
Pregnant women Three months from the time they received care (and during the 60 day period beginning on the last day of pregnancy)
Children younger than age 1 Three months from the time they received care

 

UI Hospitals and Clinics staff in the Department of Social Service can assist patients in applying for Medicaid while they are here as a patient. Patients also can apply for Medicaid by:

  • Calling Iowa DHS at 1-855-889-7985 (press 4, then press 2).
  • Going online to dhsservices.iowa.gov.
  • Visiting your local DHS office. Go to dhs.iowa.gov/dhs_office_locator to find the DHS office near you.
  • Talking to one of our Health Care Benefits Assistance Program (HCBAP) social workers. Call 319-356-2207 to schedule an appointment for help filling out a Medicaid form or if you have questions.

Patients who have been approved for Medicaid coverage should contact Registration at 319-356-4498 to have this information added to their account. Patients with questions may call Patient Billing Services at 866-393-4605 for assistance.

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