HHSC determines Medicaid eligibility effective dates for an applicant as follows.(1) Medicaid coverage begins on the earliest day of the application month on which the applicant meets all eligibility criteria.(2) Retroactive coverage may begin as early as three months before the application month.(3) The Medicaid coverage of an applicant whose household income, as calculated under §366.1113 of this chapter (relating to Calculation of Household Income), exceeds the Medically Needy Income Limits (MNIL) may spend down the excess amount of income to pay unpaid medical bills and qualify for Medicaid. Medicaid begins on the earliest day of the month of potential eligibility on which spend down requirements are met.(4) Once a pregnant woman meets spend down, she remains continuously eligible through her pregnancy and the end of the month in which the 12-month postpartum period ends and is not required to meet spend down again until the end of her 12-month postpartum period.