Title 16
16000 Federal Poverty Level Related Programs
16210 Limitations on Retroactive Coverage
Retroactive Medicaid eligibility is discussed in the common eligibility section of the Medical Assistance Manual. The demonstration waiver eliminates prior quarter eligibility. Retroactive Medicaid coverage is NOT available to any individual who, in the month of application, is eligible for enrollment under the Diamond State Health Plan or Diamond State Partners.
Certain individuals, who are excluded from the Diamond State Health Plan or Diamond State Partners, may be found eligible for retroactive Medicaid. Individuals who may be found eligible for retroactive Medicaid are:
• those who are entitled to or eligible to enroll in Medicare,
• those receiving long term care services (nursing facility and the home and community based waivers),
• those living out-of-state but considered Delaware residents, such as a child placed out-of-state by DSCYF, and
• individuals who have coverage under Military Health Insurance for Active Duty, Retired Military, and their dependents.
The individual must meet one of the above exclusions in the month of application in order to be eligible for retroactive Medicaid.
