Medicaid Retroactive Coverage: How To Get Help With Past Due Medical Bills

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No one was prepared for COVID-19 this year and because of that many families are dealing with unexpected and expensive medical bills. 

One option for low-income families who are receiving hospital bills that they cannot afford is applying for a relatively unknown benefit called Medicaid Retroactive Coverage.  This program can help you with the cost of medical bills if you qualify. 

In this article I will explain what retroactive Medicaid is, the medical services it covers, who qualifies and how to apply for the financial assistance. 

What Is Medicaid Retroactive Coverage?

This benefit is offered by your state’s Health and Human Services Commission that helps you to pay for past due medical bills that would be covered by Medicaid insurance. 

How Medicaid Retroactive Coverage Works

The purpose of the program is to help you with medical bills that were received up to 3 months prior to you having any health coverage. An example of this would be you getting hospitalized last month, applying for Medicaid this month, and Medicaid covering the cost of those medical bills. 

This program offers retroactive coverage, because applying for Medicaid with all your mental energy can be difficult. Trying to do this while sick or injured would make the process even harder. This is why Medicaid Retroactive Coverage will provide you an extended amount of time to apply for coverage. Even after death a family member can potentially qualify to have their medical bills paid by this Medicaid program. 

Editor’s note: I will mention this many times in this article, but each state has different qualifications, therefore you will need to contact your state’s Health and Human Services Commission. 

Will Medicaid Pay For Past Medical Bills? 

Medical bills can be covered under Medicaid Retroactive Coverage as long as the medical services occurred within the Medicaid retroactive period (generally past 3 months) and you qualify for Medicaid. The exact time frame will depend on your state’s Health and Human Services Commission though. 

Other medical bills that retroactive Medicaid may cover are: 

• Skilled nursing
• Hospice
• Hospitalizations
• Out-patient services
• Lab tests
• X-rays
• Home health care
• Prescription assistance
• Durable medical equipment
• Transportation for PCP appointments

Now that you have a better understanding of how retroactive coverage works, let’s discuss the qualifications. Meeting these qualifications will be necessary to getting Medicaid to pay for past medical bills.   

Qualifications For Medicaid Retroactive Coverage

To qualify for help paying past due medical bills you will need to meet the following qualifications: 

1. Qualify for Medicaid in your state
2. Meet the requirements for Medicaid Retroactive Coverage

We will talk about both of these in more detail below. 

Qualify For Medicaid in Your State 

To receive this state benefit you must first qualify for Medicaid. Each state has different requirements for Medicaid, therefore you must contact your Health and Human Services Commission to learn more about qualifications. 

An example of qualifications can be found below for my state which is Texas. Each state has different qualifications, although Texas is in the lower half of Medicaid spending, quality, and eligibility therefore you shouldn’t be discouraged if you do not meet the criteria below. 

• Children up to age 20 who live wit their parent/guardian
• Pregnant women
• Adults who are caring for a child in their home who receives Medicaid
• Adults who were in foster care at age 18 or older
• Have a disability 
• Be over 65 

In addition your household must be considered low-income. For Texas the income limits for Medicaid are: 

House Hold Size	Monthly Income Limit
1	$25,265
2	$34,136
3	$43,006
4	$51,876
5	$60,747
6	$69,617
7	$78,488
8	$87,358

 

To learn more about your state’s qualifications for Medicaid you can visit Benefits.gov. 

Qualify For Medicaid Retroactive Coverage 

The following qualifications for retroactive Medicaid coverage come from the Texas Application for Prior Medicaid Coverage.  Although you may live in a different state you can use these qualifications as a way to determine if you should apply. 

Medicaid’s Conditions To Receive Help With Past Due Medical Bills 

In Texas you can have medical bills covered dating 3 months back. These are the conditions that must be met to receive help with hospital bills. 

1. You received medical services within the 3 month window that you applied for help. 
2. Provide your medical bills are unpaid or the services were provided by the state
3. Your or your household member would have been eligible for Medicaid last month

In addition to the conditions above you will need to answer questions about current income, plans to file taxes, and your household members. 

Apply For Medicaid and Retroactive Medicaid 

To apply for retroactive Medicaid and regular Medicaid you have 3 options that all involve contacting your local Health and Human Services Commission. 

Editor’s note: Health and Human Services Commission is the agency in your state that manages the Medicaid program. You can also apply for programs like SNAP (food stamps), WIC, and CHIP.  

1. Apply online through your state’s Health and Human Services Commission.  Texas residents can visit Your Texas Benefits to apply for Medicaid. 
2. You can apply via phone by calling your state’s Health and Human Services Commission. To apply for Medicaid in Texas call 877.541.7905. 
3. Find a local Health and Human Services Commission or Medicaid office near you.

Section L On The Medicaid Application Helps To Determine Eligibility For Medicaid Retroactive Coverage

When completing your Medicaid application it is very important to pay attention to these questions in Section L. This section directly relates to Medicaid Retroactive Coverage, so make sure you answer these questions.

 

 

Download Your Medicaid and Prior Medicaid Coverage Application (Texas)

Below you will find Medicaid applications for residents in the state of Texas in both English and Spanish. 

• Download Your Texas Medicaid Application
• Download Your Texas Medicaid Application (Spanish)

You can download your Texas application for Prior Medicaid Coverage with the links below. 

• Download Medicaid Retroactive Application
• Download Medicaid Retroactive Application (Spanish) 

 

Conclusion

Whether you qualify for Medicaid Retroactive Coverage will be determined by your state’s Health and Human Services Commission. That being said a summary of how the process generally works is: 

• Medicaid can potentially cover medical bills dating back 3 months. 
• To receive help with your past due hospital bills you will need to qualify for Medicaid in your state. 
• You will also need to meet the criteria for Medicaid Retroactive Coverage. Essentially this means you received medical treatment within the past 3 months, have unpaid medical bills, and you qualify for Medicaid. 
• Also you must complete applications for both Medicaid and Prior Medicaid Coverage as well as show proof of your unpaid medical bills. 

For more information about this Medicaid program you can contact your state’s Health and Human Services office. If you live in Texas you can call the Texas Health and Human Services Commission at 877.541.7905 or visit Your Texas Benefits. 

Lastly, if you do not qualify for retroactive Medicaid another option for assistance with hospital bills is the Hill-Burton program. This program has been around since 1946 and covers medical costs for individuals who cannot afford their medical bills.  To receive help paying for healthcare you must have received treatment at one of the Hill-Burton facilities listed here. Funds are distributed on a first-come, first-serve basis each year, therefore if your hospital is affiliated with the Hill-Burton program speak with your social worker as soon as possible.