Noteworthy News

Medicaid Retroactive Eligibility: A Dying Policy?

A growing number of states are ending or limiting retroactive eligibility for Medicaid:  the practice of Medicaid reimbursing providers for the care they deliver to Medicaid-eligible patients for up to three months even if those patients had not previously enrolled in Medicaid.

Arkansas, Indiana, and New Hampshire have ended the practice for some categories of Medicaid patients and Iowa joined them on November 1.  In addition, Delaware, Maryland, Massachusetts, and Utah impose some limits on retroactive Medicaid eligibility for at least some Medicaid-eligible individuals.

While the purpose of retroactive eligibility ostensibly is to ensure a health care safety-net for low-income individuals, critics of the practice maintain that it encourages people to ignore addressing their health insurance needs, whether for Medicaid or private insurance, until after they have been injured or become ill.  Health care providers, on the other hand, argue that their focus when such patients turn to them for care should be on restoring those patients’ health and not on worrying that they will not be paid for their efforts.

Learn more about this complicated issue and some of the evolving views about in the Kaiser Health News article “Some States Roll Back ‘Retroactive Medicaid,’ a Buffer For the Poor – And for Hospitals,” which can be found here.

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