What is Medicaid Retroactive Eligibility, How It Works & Who Is Eligible

Summary
Retroactive Medicaid will cover long-term care costs for up to three months prior to the date of one’s application, as long as the applicant was eligible during that time. This can be especially helpful if you or your loved one has a sudden need for long-term care before you’ve applied, or even thought about applying, for Medicaid. While it’s most commonly used with Nursing Home Medicaid, Retroactive Medicaid can also be used in some states to cover in-home care costs for seniors applying for Home and Community Based Services (HCBS) Waivers or Aged, Blind or Disabled (ABD) Medicaid.

Last Updated: Jan 04, 2025

What is Retroactive Eligibility?In Nursing Homes At Home via HCBS Waivers or ABD Medicaid Who is Eligible? Process for Applying

What is Retroactive Eligibility for Medicaid Long Term Care?

Medicaid Long Term Care is for people who are older or have a chronic illness and are considered financially limited in their state of residence. For seniors who meet the financial and medical criteria, Medicaid Long Term Care will cover all nursing home expenses, or it will cover long-term care benefits provided in the beneficiary’s home, which can include assisted living residences and memory care units for people with Alzheimer’s disease or other dementias in certain states

But what if a financially limited senior needs long-term care before applying for Medicaid benefits? They might accrue significant debt paying for long-term care while they apply for Medicaid and wait for a response from the state, or their family may have to cover bills the state could have been paying. Retroactive Medicaid is meant to act like a financial safety net in these situations.

Once the applicant is accepted, Retroactive Medicaid will cover their long-term care expenses for the three months prior to their application date, as long as they were eligible during that time. Retroactive Medicaid will cover unpaid bills, and in some cases it will also reimburse the applicant or their family for expenses they paid out-of-pocket during that time. So, it’s important for applicants and their families to carefully track and document all of their long-term care expenses from this time.

As mentioned, the need for retroactive coverage most commonly occurs because of a sudden or unexpected illness or traumatic event, like a heart attack or stroke. But it can also happen because there was some kind of delay when it came to completing or submitting the Medicaid application, which is a complicated process. Or perhaps the response from the state took longer than expected.

Toolbox: To get advice on the basics of applying for Nursing Home Medicaid with a simple, step-by-step guide, click here. Or you can consult with a professional.

Retroactive Medicaid Coverage in Nursing Homes Care

Retroactive Medicaid is often useful for people who need Medicaid’s nursing home coverage. A sudden change in condition or unexpected move into a nursing home can be incredibly difficult and expensive (usually more than $7,000 per month), and Medicaid’s retroactive coverage makes the move easier.

For eligible applicants, Medicaid will cover all the expenses associated with nursing homes, including room and board. So, Retroactive Medicaid will also cover all expenses associated with the nursing home for the three months prior to the application date. This does not include a private room, cable television, private phones, comfort items or any specialized food that isn’t deemed medically necessary.

Almost all states offer Retroactive Medicaid for Nursing Home Medicaid applicants, but there are some exceptions, including Florida and Arizona. To find out if Retroactive Medicaid is available in your state, and what programs it applies to, contact your local Medicaid agency or consult with a professional.

Important: Retroactive Medicaid will cover the cost of nursing home care for 90 days prior to the application date, but it may be difficult to find a nursing home that will allow an individual to move without immediate payment. Often, families must pay out-of-pocket and hope for reimbursement via Retroactive Medicaid.

Retroactive Coverage at Home with HCBS Waivers or ABD Medicaid

Not all states offer Retroactive Medicaid for their in-home long-term care coverage via Home and Community Based Services (HCBS) Waivers or Aged, Blind or Disabled (ABD) Medicaid. Where it is offered, what is retroactively covered will depend on the state’s HCBS Waivers or ABD Medicaid, which can offer very different benefits depending on the program and the state. However, the in-home benefits covered by Retroactive Medicaid might include:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Assistance with the Instrumental Activities of Daily Living (cleaning, shopping, cooking, laundry, paying bills, medication management, etc.)
In-home nursing services
Home modifications for safety and accessibility
Personal Emergency Response Systems
Vehicle modifications
Meal delivery
Transportation

Who is Eligible for Retroactive Medicaid Coverage?

Medicaid Long Term Care applicants are eligible for Retroactive Medicaid coverage for three months prior to their application date if their application is accepted and they were eligible for Medicaid during those three months.

To be eligible for Medicaid Long Term Care, applicants must meet certain financial and medical eligibility requirements. The financial requirements can change depending on the applicant’s state of residence, their marital status and the Medicaid program they’re applying for. However, in most states in 2025, the individual asset limit for Nursing Home Medicaid, HCBS Waivers and ABD Medicaid is $2,000. The individual income limit for Nursing Home Medicaid and HCBS Waivers in most states in 2025 is $2,901/month, while the individual income limit for ABD Medicaid in 2025 ranges from $967/month to $1,795/month, depending on the state.

The medical criteria in all states for Nursing Home Medicaid, and for most HCBS Waivers, is needing a Nursing Facility Level of Care (NFLOC). Some HCBS Waivers only require applicants to be at risk of needing a NFLOC. In general, a NFLOC means needing the kind of constant care and supervision normally associated with nursing homes, but exactly how a NFLOC is defined and measured can change depending on the state.

Attention: If a senior dies with unpaid medical bills, it is possible to file for Retroactive Medicaid on their behalf. The state may pay these bills, but there are also cases where the state has denied these posthumous applications.

What’s the Process to Apply for Retroactive Medicaid Coverage?

The application process for Retroactive Medicaid can vary by state. Some states require a separate application. In other states, the applicant simply checks off a box on the primary Medicaid application.

No matter the state, applicants must prove they met Medicaid’s eligibility requirements during the time they are applying for retroactive coverage, whether its the full three months before the application date or just part of that time. The proof will be official documents that detail their financial holdings. Some or all of these documents may be needed for the primary Medicaid application, but there may be extra documents needed for the retroactive coverage.