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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 January 2026 Subchapter Subject Page ending with Page M0130 APPLICATION PROCESSING M0130.300 12

D. Application Disposition 1. General Principle Each application must be disposed of by a finding of eligibility or ineligibility as supported by the facts in the case record, unless the application is withdrawn or terminated (see M0130.400). If an applicant dies during the application process, his eligibility can only be established for the period during which he was alive. If an applicant (other than a Medicare beneficiary, HPE, or deceased individual) is ineligible for MA for any reason other than the inability to determine eligibility, a referral to the VIM must be made so that his eligibility for the APTC in conjunction with a Qualified Health Plan (QHP) can be determined. Individuals who have Medicare, who are incarcerated, who are enrolled as HPE, and deceased individuals and are not referred to the VIM. 2. Entitle- ment and Enrollment a. Entitlement Entitlement to medical assistance is based on the application month. However, entitlement cannot begin prior to an individual’s date of birth, and cannot continue after an individual’s date of death. See section M1510.100 for detailed entitlement policy and examples. If applicants indicate that they have been receiving MA (Medicaid or Children’s Health Insurance Program) coverage in another state prior to moving to Virginia, instruct them to contact the eligibility worker there and request that the coverage be cancelled, if they have not already done so. Individuals are no longer considered residents of the other state once they have moved to and intend to reside in Virginia and are not entitled to receive services paid for by the other state’s MA program. Enrollment may begin with the month of application or the earliest month in the application’s retroactive period that they met the residency requirement per M0230. b. Enrollment MA enrollees must be enrolled in the MES, either through the system interface with the eligibility determination system or by submitting a coverage correction request through the Coverage Correction Portal (CCP) on the MES website., Home | MES. Note: The MES was implemented in April 2022. Prior to April 2022, the Medicaid Management Information System (MMIS) was used for enrollment and claims processing. References to MMIS in the Medical Assistance Eligibility Manual will be updated as other policy revisions are made. When an individual who does not have Medicare is eligible for only limited MA benefits, such as Plan First, a referral to the VIM must be made so that eligibility for the APTC in conjunction with a QHP can be determined. 3. Notification to Applicant

Either a Notice of Action generated by the eligibility determination system or the equivalent form #032-03-006 (available at the DSS Fusion website) must be used to notify the applicant of the specific action taken on the application. The notice must be sent to the authorized representative, if one has been designated.