Retroactive Medi-Cal Approval

Case Situation

55 years old single female with no income applies for Medi-Cal. She also requests retroactive Medi-Cal for the 3 months prior to the current application month to cover for her medical bill. MAGI MC eligibility was cleared and approved.

Refer to CalSAWS "Job Aid (JA) Retroactive Medi-Cal", for additional Retro MC processing instructions.

  1. On the Medical Detail page:
    1. Click the Edit button.
    2. In the Program Persons page section, click the Edit button for the applicant requesting Retro Medi-Cal.
  2. On the Medi-Cal Person Detail page:
    1. Enter the Month Retro Medi-Cal Was Requested in the Month field in the Retro Months page section.
    2. Select the Requested Medi-Cal Type from the Requested Medi-Cal Type drop down list.
    3. Click the Add button in the Retro Months page section to add additional Retro Months and click the Save and Return button.
    4. Click the Save and Return button on the Medical Detail page.

Note: You will need to update the Administrative Role of the Primary Applicant Begin Month to align with the requested retro months. And to update the Customer Options record of Verification Consent with the Begin Date in same month as the 1st month of Retro Medi-Cal.

      3. Complete other Data Collection pages relevant to the case.

      4. Request Magi Determination and Run EDBC.

      5. The Medi-Cal EDBC Summary page indicates Pass results for the retro and ongoing months.

      6. Accept and Save the results.

Transactions Generated by CalSAWS to MEDS

  • Three Add (EW20) transactions will be generated to MEDS for the retro months. A ‘Close Period’ ESAC of 6 is sent with each transaction.
  • Add (EW20) transactions for the application, current and future months are also sent to MEDS. As CalSAWS considers each authorized month a closed period of eligibility, a TERM-DT and a TERM-REAS of ‘99’ will be displayed on the INQM screen. Eligibility for future month will appear under the Pending column until MEDS renewal.

Refer to MC HB Chapter 4: Application, Section Retroactive MC for detailed information.

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