227.13 Family Planning MA Retroactive Medical Assistance (MAM)

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Family Planning medical assistance (MA) applicants are entitled to retroactive medical assistance, if eligible, for the 3-month period directly preceding the individual’s application date. The applicant can use DFA Form 800FP, Application for Family Planning Medical Assistance, to request retroactive coverage or DFA Form 779, Application for Retroactive Medical Assistance. The request must be made no later than 9 months from the first date of the retroactive period for which coverage is requested.

The eligibility determination process for retroactive periods is the same as all other programs; it is determined one month at a time, and for each retroactive period, the Family Planning Family Services Specialist must determine if all the following criteria apply:

• the individual received medical services which would have been covered by Family Planning MA; and

• the individual would have been eligible for Family Planning MA in the period the service was provided, if an application had been filed.

Applicants for retroactive Family Planning MA must provide the same kind of proofs for the retroactive periods that have to be provided for a current application, although the applicant does not have to be currently eligible to apply, and be eligible for, retroactive assistance.

References: He-W 509, He-W 606.90, He-W 626, He-W 680.02, RSA 126-A:4-c, Section 1902(a)(10)(A)(ii) of the Social Security Act [42 U.S.C. 1396a(a)(10)(A)(ii)], 42 USC 1396r-1c, 42 U.S.C. 1396a(ii)(3)