Retroactive Payments for Nursing Facilities Reinstated

In 2017, consistent with the state fiscal year (SFY) 2018/19 Human Services appropriations bill, DHS requested to eliminate retroactive benefits for all Iowa Medicaid eligibility groups that were previously eligible to receive up to three months of retroactive coverage. The Centers for Medicare and Medicaid Services (CMS) approved this request, with an exception for pregnant women and during the 60-day period beginning on the last day of the pregnancy and infants under one year of age, who continue to receive the 3-month retroactive eligibility period.

Today, in accordance with Senate File 2418 passed by the Iowa Legislature during the 2018 session, DHS is revising its policy and will reinstate a 3-month retroactive Medicaid coverage benefit for applicants who are residents of a nursing facility at the time of application and are otherwise Medicaid-eligible. Reinstatement of retroactive payments for residents of a nursing facility was one of LAI’s top legislative priorities for the 2018 legislative session.

This revised policy is effective for new Medicaid applications filed on or after July 1, 2018. System changes in alignment with this policy revision will be made effective October 1, 2018. Providers who are assisting applicants impacted by this policy change with applications filed between July 1, 2018, and the effective date of the system changes should have the applicant, the applicant’s Power of Attorney (POA), or the applicant’s authorized representative contact the Centralized Facility Eligibility Unit (CFEU) to request that retroactive eligibility be determined for the application previously submitted during the effected time frame. The request can be made by phone, email, or mail to CFEU:

Phone: 1-877-344-9628

Email: [email protected]

Mail: CFEU Imaging Center #1 417 E. Kanesville Blvd. Council Bluffs, IA 51503

If you have questions, please contact the Iowa Medicaid Provider Services Unit at 1-800-338- 7909, Monday - Friday, from 7:30 a.m. to 4:30 p.m., or by email at [email protected].