Retroactive Medi-Cal Coverage: New Timing Trap
Beginning January 1, 2027, a federal law change (the One Big Beautiful Bill Act (OBBBA)) will significantly reduce how far back Medi‑Cal can pay – or reimburse – for medical expenses where the Medi-Cal applicant was otherwise Medi-Cal-eligible during this “retroactive period.” This change affects non‑MAGI (and MAGI) Medi‑Cal applicants, including those seeking nursing‑home and other long‑term care coverage, and it makes timing the application more important than ever.
This sort of reimbursement claim is referred to as a Conlan claim.
A Conlan claim is a request that Medi‑Cal reimburse or pay for long‑term‑care or other medical expenses incurred before the Medi‑Cal application was filed, so long as:
The applicant was otherwise eligible during the retroactive period, and
The expenses fall within the allowable retroactive months.
What Changed?
Under the One Big Beautiful Bill Act (OBBBA), Medi‑Cal’s retroactive coverage period for non‑MAGI programs is shortened to two months (one month for MAGI programs). This means Medi‑Cal can only cover – and reimburse – eligible medical expenses incurred during those limited retroactive months. Through December 31, 2026, the potential period of retroactive Medi-Cal coverage and reimbursement is three months.
Importantly, Medi‑Cal will not reimburse medical expenses incurred outside that retroactive window, even if the applicant was otherwise financially and medically eligible at the time the expenses were incurred.
How Medi‑Cal Timing Actually Works
There are two timing rules families often confuse:
Medi‑Cal eligibility begins on the first day of the month in which the application is filed, not on the date the application is submitted. If you apply in March, your eligibility begins March 1, even if the application is submitted on March 30.
Retroactive coverage is measured in whole months prior to the application month, not backward from the application filing date.
These rules can work in a family’s favor – but only if the application is filed promptly.
A Simple Example
Assume the following facts after January 1, 2027:
A Medi‑Cal applicant enters a nursing facility on March 10.
The family pays the facility $14,000 for care provided in March and April, while gathering documents.
The Medi‑Cal application is submitted on June 20.
Because Medi‑Cal eligibility begins June 1, the two‑month retroactive period covers April and May only. March falls outside the retroactive window – even though the application was filed less than 90 days after care began.
Result:
April expenses may be reimbursed (if all eligibility criteria are met).
March expenses are permanently non‑reimbursable.
Waiting until June to file cost the family thousands of dollars that would otherwise have been recoverable.
The Key Takeaway
Under current law, eligibility alone is not enough. Medi‑Cal will only reimburse expenses incurred during months that fall within the shortened retroactive coverage period. Filing the application even one month later than necessary can mean losing reimbursement for care that was already paid for – and cannot be undone.
With long‑term care costs often exceeding $12,000 per month, early filing is no longer just good practice. It is essential.
Important Disclaimer
This article is for general informational purposes only and does not constitute legal advice. Medi‑Cal rules are complex, fact‑specific, and subject to change. In addition to potential reimbursement, other critical questions include asset spenddowns, income rules and share of cost, and potential issues with California estate planning documents – an outdated revocable living trust or power of attorney, to name one example.
Take Action
If you or a loved one are facing long‑term care needs in California or have already begun paying for care, do not wait to seek legal guidance. Early action can preserve eligibility and prevent irreversible financial loss. To discuss your situation, contact a California elder law attorney to schedule a consultation before critical Medi‑Cal deadlines pass.
