4-003 Effective Date of Medical Eligibility
469 NAC 4-003
If an individual is eligible for medical assistance one day of the month, s/he is eligible the entire month. The effective date of eligibility for MA is determined as follows:
1. Prospective eligibility is effective the first day of the month of request if the client was eligible for MA in that same month and had a medical need.
Exception: For AABD/MA or SDP/MA blindness/disability cases, the date of prospective eligibility begins -
a. With the first month of entitlement for SSI or the month of onset of a disability which is established for RSDI (when this date is after the month of request); or
b. The first day of the month in which the State Review Team determines disability to exist, when this date is after the month of request.
Prospective periods of eligibility for AABD/MA disabled cases not covered by an SSI/RSDI disability decision may be submitted to the State Review Team for a disability decision (see 469 NAC 2-007.03B ff.). The person must have a medical need and meet other eligibility criteria.
2. Retroactive eligibility is no earlier than the first day of the third month before the month of request, if the following conditions are met:
a. Eligibility is determined and a budget computed separately for each of the three months;
b. A medical need exists; and
c. Elements of eligibility are met for each month.
An applicant may be eligible for the retroactive period (or any single month(s) of the retroactive period) even though ineligible for the prospective period.
Retroactive periods of eligibility for AABD/MA blind/disabled cases not covered by an SSI/RSDI disability decision may be submitted to the State Review Team for a disability decision. The individual must have had a medical need and have met other eligibility criteria during those months.
If the client was not eligible for one or more months of the retroactive period, the case must contain documentation of the ineligibility.