PM 06-08-03-f

new text(FCRC) Refer adults to the All Kids unit if they request medical backdate on a Share or Premium case. Only the All Kids unit can authorize FamilyCare Share or Premium backdate.

FamilyCare Share

(All Kids Unit) A medical backdate for FamilyCare Share may be requested verbally or in writing. Parents and caretaker relatives may receive up to a 3 month backdate from the date of application plus the month of application and the months prior to the first regular roll month. Determine financial and nonfinancial eligibility before authorizing coverage.

FamilyCare Premium

(All Kids Unit) Staff sends Request for FamilyCare Backdate, Form HFS 243FC1 (1 Person), or HFS 243FC2 (2 People), to the person who requests medical backdate under FamilyCare Premium.

The family sends the form, with payment for the requested month(s), to HFS Bureau of Fiscal Operations. The backdated coverage is not authorized until the payment is received by HFS. Once the payment is received, the All Kids unit authorizes the backdate.

Up to a 3 month backdate prior to the month of application through the current processing month may be requested. Months of coverage for the FamilyCare backdate do not have to be consecutive. The adult may choose any of the eligible months as long as the premium is paid for the months chosen.

Once the premium is paid and the FamilyCare backdate coverage is authorized, the month of coverage cannot be changed to a different month. The adult may choose to pay for additional eligible months if needed.

Determination of Premium Due for Backdate Month

The premium due for FamilyCare backdate is the difference between the number of adults requesting the backdate and the number of persons billed for Premium coverage for the months requested.

New Approvals

The premium due for the backdate request is based on the number of adults requesting a backdate when they are approved for assistance as a result of a new application. The first adult pays $15 per month for the backdate period. When two adults in the household request coverage for the same backdate month, the premium is $25 per month.

Example 1: Ms. D applies for Family Health Plans for herself, her husband and son on July 15th. She has medical bills from June for herself and husband and a bill from May for her husband. Countable income for the backdate period and ongoing is within Premium Level 1. Ms. D's Premium Level 1 case is approved effective September. Ms. D requests a backdate only for the months she and her husband have medical bills. Ms. D requests the following months: June for herself and her husband and May for her husband only. Ms. D must pay $40 before the backdate coverage is authorized.

Application Date 7/15 Mr. D Ms. D Total Premium
June Yes Yes $25
May Yes No $15
Total Premium Due -- -- $40

Request for Additional Family Member

When the adults are approved for assistance as a result of a request to be added to an active case, the premium due for the backdate request is based on the difference between the cost for the adult(s) requesting the backdate and the cost for the whole family's premium.

Example 2: Mr. E has an active Premium level 1 case for his son; the premium amount is $15. On July 2nd, he requests FamilyCare Premium Level 1 for himself and his wife. Countable monthly income is within the Premium Level 1 standard. Mr. E and his wife are added to the Premium Level 1 case effective August. The new premium amount is $30 for three.

Mr. E requests a 3 month backdate for his wife plus the month of request (July). He chooses only the month of request (July) for himself. The premium for Mrs. E's backdate request for April, May and June is $10 per month ($25 for two-$15=$10).  The premium for Mr. E's and Mrs. E's request for July is $15 ($30 for 3-$15=$15). The total of $45 as shown in the table below is due before the backdate coverage is authorized.

Request Date 7/2 Mr. E Mrs. E Premium Due
April No Yes $10
May No Yes $10
June No Yes $10
July Yes Yes $15
Total Premium Due -- -- $45

Example 3: Ms. F has a Premium Level 1 case for her 5 children and requests coverage for herself on August 3rd. Her income is within the Premium Level 1 standard and she is added to the case effective October. Ms. F requests a 3 month backdate and the months prior to October. The current premium is $40 per month for her children which is the maximum premium under All Kids/FamilyCare. Because she is already paying the maximum premium, she does not have to pay for the backdate months.

Example 4: Mr. and Mrs. G have an active Share case for their two children and request coverage for themselves on August 14th. Their income is now within the Premium Level 1 standard. They are added to the Share case and recalculated to Premium Level 1 effective October. The children remain Share eligible until the next renewal. Mr. and Mrs. G request the following months for backdate coverage.

Request Date 8/14 Mr. G Mrs. G Premium Due
May Yes No $15
June No No $0
July Yes Yes $25
August No No $0
September No Yes $15
Total Premium Due -- -- $55