1313 Prior Quarter Coverage

Revised 12/19/2023

Policy

This section describes application requirements that are specific to Prior Quarter Coverage.

1) AHCCCS Medical Assistance (MA)

To qualify for Prior Quarter Coverage of MA, the person must:

• Be pregnant, in the 60-day postpartum period, or under age 19;

• Have a medical expense in a Prior Quarter month. The medical expense can be paid or unpaid; and

• Meet all eligibility requirements in the month the medical service occurred.

 

2) SLMB and QI-1

To qualify for Prior Quarter Coverage of SLMB or QI-1, the person must:

• Be pregnant, in the 60-day postpartum period, or under age 19;

• Have received Medicare Part B in a Prior Quarter month; and

• Meet all eligibility requirements in the month in which Medicare Part B was received.

NOTE     Prior quarter coverage for QI-1 cannot begin any earlier than January of the current calendar year.

 

3) Effective Date of Prior Quarter Coverage:

The prior quarter period depends on when the Prior Quarter Coverage is requested. See the following table for details:

If the request for Prior Quarter Coverage…	Then…
Is submitted at the same time as the application for Medical Assistance (MA).	The Prior Quarter Coverage is the three months before the application month.
Is NOT submitted at the same time as an application for MA AND The MA application is still pending.	The prior quarter period is the three months before the application month.
Is NOT submitted at the same time as an application for MA and MSP AND The MA application has already been completed.	The prior quarter period is the three months before the month the customer’s request is submitted.

 

See How to enter Prior Quarter Coverage in HEAplus for details.

Information about enrollment in AHCCCS fee-for-service for the Prior Quarter Coverage months can be found in MA1103.

 

Definitions

Term	Definition
Pregnant	A woman expecting the birth of one or more children.
60-day Postpartum Period	A 60-day period starting the day the pregnancy ends. This period applies to a customer who was not enrolled in AHCCCS while pregnant. A customer who is applying for AHCCCS and was pregnant or in their 60-day postpartum period in any of the 3 months before their application month, may be eligible for Prior Quarter Coverage.
Postpartum period	A 12-month period starting the day the pregnancy ends. This period ends on the last day of the 12th month. Customer must be enrolled in AHCCCS while pregnant to be in the 12-month postpartum period as it applies to this group. See Pregnancy and Postpartum for examples.

Timeframes

The standard MA application timeframes apply to Prior Quarter Coverage. Prior Quarter eligibility is determined on a month-by-month basis.

 See MA1311 for policy about processing multiple months.

 

Legal Authority

Program	Legal Authorities
ALTCS BCCTP SSI-MAO Freedom to Work Child Adult SLMB QI-1 Caretaker Relative Pregnant Women	42 CFR 435.915 R9-22-101 & 303