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West Virginia Income Maintenance Manual Chapter 10

West Virginia Income Maintenance Manual Page 69 Chapter 10 The Case Maintenance Process

10.17 AFDC-RELATED, SSI-RELATED, AND SSI-RELATED NON- CASH ASSISTANCE MEDICAID 10.17.1 CHANGE IN INCOME AND DEDUCTIONS Case maintenance action is required to update the eligibility system when a Medicaid assistance group (AG) has a change of income. The Worker must take the following actions: • If the AG did not previously have a spenddown and continues not to have one, no other action is necessary. • If the AG previously did not have a spenddown and now has one, the case is closed after advance notice. The following procedures are used in this situation: o The AG is closed and reopened with a new period of consideration (POC). The new POC must not cover any period of time in which the case was in a period of eligibility (POE). o The client must be notified about his spenddown and the procedures that now apply. 10.17.2 CHANGE IN THE POC When the client requests coverage for backdated months after initial eligibility has been established, the Worker must evaluate eligibility for any months for which coverage is requested. Information necessary to determine eligibility is requested from the client, including medical bills to meet spenddown, if applicable. The client must not receive coverage for more than a six-month POC. Change in the POC Example: Ms. Pine provided medical bills to meet her spenddown and was approved for Medicaid with a six-month POC of November 2010 through April 2011. In December, Ms. Pine discovers medical expenses she owes for services incurred in October that will meet her spenddown and requests her Medicaid coverage be backdated to October. If eligibility is