Medicaid Reimbursment

Medicaid’s Reimbursement Program

The Medicaid Reimbursement Program allows the family, but not the spouse, to pay for their loved one’s home care services during the Medicaid pendency period and file a request for reimbursement once the application had been approved. Medicaid pendency period is the time between the filing of the application and the actual starting date of the home care services. Additionally, if the applicant was financially eligible three months prior to filing the application, the family can request reimbursement for this period as well.

Several issues to think about when considering reimbursement. First, the home care agency providing the services during the pendency period must be a Medicaid approved agency; second, Medicaid reimburses the family at the Medicaid rate; and thirdly, Medicaid follows the following rules: 1) Medicaid is allowed 45 days to make a decision regarding regular Medicaid applications, and 90 days if the application contains a pooled-income-trust; and 2) should Medicaid take longer than the allowed period, the family is allowed to file a request for 100% reimbursement.