Ohio court denied Assisted Living Waiver retroactive benefits


The US Court of appeals ruled against the application of retroactive benefits for Assisted Living Waiver applicants. In most nursing home settings a patient is allowed to seek retroactive benefits for up to 3 months from the date of application if they are considered eligible during those months. Because of lax waiver rules, the court chose not to apply the same standard to waiver applicants. The court ruled that the medical necessity test requires an assessment and benefits cannot begin until the assessment is performed. Only prospective benefits apply once all eligibility factors are satisfied. For more information, click here.