Page 82

I. Entitlement and Enrollment

Entitlement for MEDICAID WORKS is dependent upon meeting the requirements listed above. All requests for Medicaid Works should be evaluated and documented even if a member is currently eligible for Medicaid under another full or limited coverage category.

There is no retroactive coverage under MEDICAID WORKS. The application date to.be.used.for.the. Medicaid.Works.determination.in the Virginia Case Management System (VaCMS) is the date the member.requested.a.Medicaid.Works.determination. The.request.may.be.in.writing.or.by.phone?.but. must.be.documented.in.the.case.comments¡.Coverage shall begin on the first day of the month following the month in which all requirements are met. If the applicant has a future start date for employment, the effective date of eligibility shall be no earlier than the first day of employment. However, unless employment begins on the first day of the month, MEDICAID WORKS enrollment will begin on the first of the following month. If the person is already enrolled in Medicaid, a new application is not required. Appendix D should be completed to gather additional information on resources. If the person is not currently enrolled in Medicaid, a full application is necessary.

The Aid Category for MEDICAID WORKS is 059. Use the following procedures to enroll the individual in VaCMS:

New Application – Applicant is Disabled and enrolled in Medicaid

1. For the month of application and any retroactive months in which the person is eligible, enroll the individual in the appropriate AC in a closed period of coverage, beginning the first day of the month in which eligibility exists. The cancel date is the last day of the month in which the MEDICAID WORKS request.was.received. Use Cancel Code 042. 2. Reinstate the individual’s coverage in MEDICAID WORKS using AC 059 beginning the first day of the following month (the first day of the month following the month in which the MEDICAID WORKS request is received). Use the same application date (the actual date of the initial application) that was used for the month of application.

DMAS approval is not required for participation in MEDICAID WORKS; however, information must be sent to DMAS after the individual is enrolled for tracking purposes. Use the MEDICAID WORKS Email Cover Sheet available at Medical Assistance Forms, and email it together with the following information to DMAS at MedicaidWorks@dmas.virginia.gov: • Documentation.of.the.MEDICAID WORKS request, • the Work Incentive Account (WIN) information (a bank account statement or verification from the bank that the account was opened), and • a pay stub showing current employment or an employment letter with start date or self- employment document(s) to verify employment. Current Enrollee 1. Cancel current coverage using Cancel Code 042.