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West Virginia Income Maintenance Manual Chapter 10

West Virginia Income Maintenance Manual Page 50 Chapter 10 The Case Maintenance Process

10.6.5.B Consideration of Eligibility under Other Coverage Groups In no instance is Medicaid under one coverage group stopped without consideration of Medicaid eligibility under other coverage groups. A child is also evaluated for WVCHIP eligibility when Medicaid under one coverage group ends. This evaluation is done before the client is notified that his Medicaid eligibility will end. Eligibility is evaluated based on case record information. The client may be required to visit the office only for completion of a Social Summary for an MRT referral. The AG does not remain active while the MRT decision is pending. See Section 2.14 for special procedures for SSI Medicaid when an individual is determined no longer disabled by SSA. 10.6.5.C Medicaid Certificate of Coverage For any individual in any Medicaid coverage group whose Medicaid benefits stopped on or after July 1, 1996, the Worker must, upon request, complete form DFA-HIP-1, Certificate of Medicaid Coverage. All individuals in the same AG with the same period of coverage may be included on the same certificate. A separate certificate must be issued for individuals who have different dates of coverage, or when all individuals do not have 18 months of coverage. 10.6.6 CORRECTIVE PROCEDURES 10.6.6.A Reimbursement for Out-of-Pocket Expenses A client is eligible to receive direct reimbursement for out-of-pocket medical expenses that would otherwise have been paid by Medicaid in these situations: EXCEPTION: • Changes in income do not affect the eligibility of pregnant women. • Also, regardless of any changes, except those specified in Section 10.7, a child determined eligible for Medicaid must have 12 months of continuous Children Under Age 19 coverage.