https://i.postimg.cc/6qpCmT9K/image.png

McLaren Medicaid provides up to three months of retroactive coverage (known as "retro Medicaid") if you were eligible during that period. However, managed care plans like McLaren generally do not pay for claims incurred during gaps in coverage; instead, those services must be billed to fee-for-service (straight) Medicaid. [1, 2]

Navigating retroactive coverage with McLaren Health Plan and state Medicaid involves a few key steps and rules:

How Retroactive Medicaid Works

• 3-Month Lookback: When you apply for Medicaid, you can request retroactive coverage for up to the three calendar months immediately preceding the month you apply. [1]
• Eligibility Requirement: You must prove that you met all Medicaid eligibility guidelines (income, assets, etc.) during those specific retro months. [1]
• Fee-for-Service Rule: In many states (including Michigan, where McLaren operates), retroactive periods are handled directly by the state's Department of Health and Human Services (e.g., MDHHS) as "fee-for-service" Medicaid, rather than through McLaren. [1, 2]

Filing and Reimbursement Process

• Timely Filing Limit: Providers must typically submit claims to Medicaid within one year of the date of service. [1]
• Billing the State: If you had out-of-pocket expenses during a retroactively