For special guidance for backdating medical benefit, review the following Medical Morsel: Case Progression and When to Approve Applicant for AABD dated 04/11/2014.
When a person is determined eligible for any cash or medical program, determine their eligibility for medical backdating. Do not backdate Assist, Moms and Babies, or AABD Medical over a period in which a person received All Kids Rebate benefits.
Backdate any month:
- for which all eligibility factors are met; and
- that is no more than 3 months before the month of application.
NOTE: See Special Backdating for Reapplications (AABD), when backdating may be for more than 3 months.
If the person has unpaid bills for a month that qualifies to be backdated, but does not want to backdate, advise the person:
- he or she may be eligible for payment of these medical bills;
- it is to his or her advantage to ask for backdating; and
- if medical assistance is not backdated, he or she may have to pay the full medical bill.
Backdate for each month that meets the criteria, unless the person says they do not want to backdate. For each eligible month, look at nonexempt income, Payment Level, the Cash Standard, the income standard, and for AABD Cash, the resource limits. Use the value of resources for each individual month backdating is requested. Compare this information to determine what kind of case to approve for the backdate month: cash and medical, regular, or spenddown. Eligibility for a backdated month may be different from ongoing medical eligibility. See WAG 17-02-05-a for backdating procedures.
For AABD(B) and AABD(D) cases, do not backdate for any month before the blindness or disability began. Use the date the Client Assessment Unit (CAU) or Social Security Administration (SSA) says the blindness or disability began. If CAU or SSA does not provide this date, decide the date using available information. Do not automatically use the date of application for AABD, Social Security (RSDI), or Supplemental Security Income (SSI), as the date the blindness or disability began.
For example, if the person's disability occurred because of an accident, use the month of the accident to determine when the disability began.
Special Backdating for Reapplications (AABD)
A person who reapplies for AABD may be eligible for more than a 3-month backdate of medical benefits in certain circumstances. He or she qualifies if:
- the Social Security Administration (SSA) found the person not to be aged, blind, or disabled, and denied or stopped his or her SSI or RSDI application or benefits; and
- the person's AABD case was canceled as a result of this decision; and
- the person appealed SSA's decision; and
- SSA reversed its decision; and
- the person reapplies for AABD and meets AABD eligibility factors.
Determine medical eligibility for each month between the last month of AABD medical coverage and the beginning month of medical coverage for the reapplication. If this period is more than 3 months, refer the case to central office to backdate (see WAG 17-02-05-a).