The state must reimburse for services provided in intervening months pursuant to Medicaid law.
Docket Number: ***** , Decision Date: August 7, 2015
Attachment: Click here to download the decision.
The Division of Family and Children Services (DFCS) denied Petitioner Medicaid benefits for covered services provided to her during the month she applied, citing its updated policy of no longer approving reimbursement for “intervening months”, i.e., the period between submission and approval of the Medicaid application. According to DFCS’ updated policy, an individual was entitled to receive reimbursement for covered expenses incurred for three months before he or she applied, and would be covered for services after approval of his or her application, but could not obtain reimbursement for covered expenses incurred between those two periods. DFCS’s action was contrary to the Medicaid Act’s mandate that it reimburse for services furnished “in or after the third month before the month” of application.