Altruis Blog

Retroactive Medicaid coverage is a feature of Medicaid that allows for the coverage of medical expenses incurred in the three months prior to a beneficiary's application, provided that the individual would have been eligible during that period. This retroactive coverage can help reduce the financial impact of Medicaid redetermination in several ways:

1. Coverage of Past Medical Expenses: Retroactive coverage ensures that healthcare providers, including FQHCs, are compensated for services rendered to patients during the period when their Medicaid coverage lapsed due to the redetermination process but before their coverage was re-established. Without this, providers would potentially face an increase in uncompensated care costs.

2. Financial Protection for Patients: For patients, retroactive coverage reduces the risk of incurring significant medical debt due to a gap in coverage during the redetermination process. This financial protection may help ensure that patients continue to seek necessary care, thus maintaining patient volume and associated revenue for providers.

3. Reduced Administrative Burden: Retroactive coverage can reduce the administrative burden of seeking payment for services provided during the coverage gap. Without retroactive coverage, providers may need to engage in extensive collection efforts, negotiate payment plans, or write off these costs as uncompensated care.

4. Stabilizing Effect: Retroactive coverage provides a sort of safety net for both healthcare providers and patients during the redetermination process. It can help maintain the financial stability of healthcare providers serving large Medicaid populations and mitigate the potential financial impacts of redetermination.

It's important to note that not all states offer full three-month retroactive coverage. The Affordable Care Act (ACA) initially required it, but subsequent policy changes have allowed states to limit or eliminate retroactive coverage, subject to federal approval. The extent to which retroactive coverage can mitigate the financial impacts of Medicaid redetermination therefore depends on state-specific policies.

Altruis offers a retroactive Medicaid solution to identify and bill all claims eligible for payment.  To learn more, check out RetroPay^TM  or contact us for a free assessment.