How to Submit Unpaid Medical Bills to Medicaid

Medicaid serves as a joint federal and state program designed to provide healthcare coverage to individuals and families who meet specific income and resource criteria. While it primarily addresses current and future medical expenses, Medicaid also offers a provision to cover past, unpaid medical bills. This mechanism, known as “retroactive Medicaid coverage,” can offer significant financial relief by covering eligible healthcare costs incurred before an individual’s formal application for benefits.

Determining Eligibility for Retroactive Medicaid Coverage

Medicaid generally provides retroactive coverage for medical expenses incurred up to three months prior to the month an application is filed. To qualify for this coverage, an individual must demonstrate that they would have been eligible for Medicaid during each of those past months. This involves meeting specific financial and non-financial criteria that were in place during the retroactive period.

Income limits are a primary determinant, varying by household size and eligibility group. Applicants must show their income for the retroactive months was below the applicable threshold. Asset limits also apply, typically for specific groups like the aged, blind, or disabled, or those seeking long-term care. These limits dictate the maximum value of countable assets; a primary residence or one vehicle are often exempt.

Beyond financial requirements, individuals must have been state residents during the retroactive period. Household composition also influences income and asset calculations. Applicants must also meet categorical eligibility requirements for the past period, such as being pregnant, a child, an adult with disabilities, or a low-income adult, depending on the state’s Medicaid expansion status.

Gathering Necessary Information and Documents

Preparing for a retroactive Medicaid application requires collecting personal and financial documents. For identification, applicants need Social Security cards, birth certificates, and government-issued photo identification for all household members. These documents confirm identity and citizenship or immigration status.

Proof of income for the retroactive period is essential, such as recent pay stubs, tax returns, W-2s, 1099s, Social Security benefit statements, or unemployment benefit statements. Proof of assets is also necessary, including bank statements, investment statements, and property deeds.

To establish residency, utility bills, lease agreements, or official mail showing a current address are required. If other health insurance was in place during the retroactive period, gather that information. Itemized statements for unpaid medical bills are essential. These statements must include:
The healthcare provider’s name and address
Specific dates of service
Relevant procedure codes
Exact amounts owed

Applicants need to obtain the appropriate state Medicaid application form. Use the gathered information to accurately complete all sections, detailing household members, income, assets, and the precise months for which retroactive coverage is sought.

Applying for Retroactive Medicaid Coverage

After compiling all necessary information and documents, submit the application for retroactive Medicaid coverage. Submission methods vary by state, including online portals, mail, or in-person at local Medicaid or social services offices.

Clearly indicate on the application that retroactive coverage is requested and specify the exact months desired. This aligns the review with the dates of service on unpaid medical bills.

Submit all supporting documentation, such as itemized medical bills, income verification, and asset statements, with the completed application. For online applications, upload scanned copies. When mailing, send copies and keep originals. For in-person submissions, provide copies for the agency.

After submission, obtain confirmation of the application. Online applications typically provide a confirmation number. When mailing, use certified mail with a return receipt. For in-person submissions, request a date-stamped copy or receipt.

Understanding the Outcome and Next Steps

After submitting the application, a processing period follows. Processing times vary, often taking several weeks or months for a determination. The agency may contact the applicant to request additional information or clarification. Promptly responding to these requests helps avoid delays.

Applicants receive official notification of the decision, whether approved or denied. If approved, Medicaid notifies healthcare providers of the retroactive coverage dates and directly pays for eligible services. Applicants should also inform their providers of the Medicaid approval and coverage dates.

If the application is denied, applicants have the right to appeal the decision. The denial notice includes information on how to initiate an appeal. Deadlines for filing an appeal vary by state, typically 30 to 90 days from the denial notice date.