Medicaid Matters Weekly is a blog series aimed to be a trusted source for timely updates, insights and expert guidance on the ever-changing landscape of Medicaid, with a special focus on long-term care. Each week we’ll highlight critical developments, how they impact your clients, and offer practical tips to keep your planning strategies sharp and your clients protected.
The Shrinking Retroactive Medicaid Coverage Window
Currently, states must cover qualified medical expenses incurred up to 90 days before a Medicaid application date – which we refer to here at LWP as retroactive payment. In other words, if clients were otherwise eligible for 90 days prior to their actual Medicaid application, they would be eligible to receive payment retroactively.
The new House reconciliation proposal – currently with review in the Senate – would limit that retroactive eligibility to just one month, beginning December 31, 2026.
This change – as part of an attempt to trim an estimated $6.5 billion in federal spending over 10 years – raises serious concerns among providers, especially in skilled nursing and assisted living facilities. Many individuals go into a nursing home as “Medicaid pending” knowing that there is this 90-day window where the facility may still get compensated by Medicaid. Now, however, industry experts are warning that nursing homes could refuse uncompensated care, worsening homelessness and hospital backlogs, as families scramble to help get loved ones eligible in a health crisis.
If one thing we know is true with Medicaid planning, it’s that timing matters. Now more than ever, families must plan and submit Medicaid applications earlier in the crisis process to ensure coverage isn’t cut off before care even begins. We need to continue to educate clients – and their families – about contacting you (the law firm) as soon as a loved one enters skilled nursing, or even during a hospital stay. Small delays could now mean thousands of dollars of out-of-pocket costs.
LWP Practice tip: If a client’s health begins to decline, encourage the family to begin collecting documentation as early as possible. Have a checklist ready to hand to them, to allow the family to gather everything to reduce the amount of time it takes to put together the Medicaid application. If admission to a facility seems likely in the next three months, start the process that early!
This has not yet passed the Senate (as of June 10, 2025) and even if it does, this won’t go into effect until December 31, 2026. Still, it’s never too early to plan – Medicaid matters.
