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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 125 Chapter 1 Application/Redetermination Process

Authority for an individual or entity to act on behalf of an applicant or beneficiary accorded under state law, including but not limited to, a court order establishing legal guardianship or a power of attorney, must be treated as a written designation by the applicant or beneficiary of authorized representation.

The power to act as an authorized representative is valid until the applicant or beneficiary modifies the authorization to the DOHS.

The authorized representative is responsible to the same extent as the client being represented, including confidentially of any information regarding the client provided by the agency and agreeing to the terms of the Rights and Responsibilities.

Examples of documents the applicant may submit with the Medicaid application to verify he has designated an authorized representative include, but are not limited to:

• Single Streamlined Application (DFA-SLA-1, Appendix C) • Application for Long Term Care Medicaid and Children with Disabilities Community Service Program (DFA-MA-1) • Durable power of attorney (POA) and/or medical power of attorney documentation, unless limited in scope • Court orders designating a guardian or conservator (signed by court) • Healthcare surrogate documentation for an incapacitated applicant (signed by physician and surrogate)

1.6.6 AGENCY DELAYS When the Department fails to request necessary verification, the Worker must immediately send the eligibility system verification checklist or form DFA-6 to request it. He must inform the client that the application is being held pending. When the verification is received, and the client is determined eligible, medical coverage is retroactive to the date eligibility would have been established. When the application is not processed within agency time limits, the application must be processed immediately upon discovery of the delay and coverage must be backdated for any prior eligibility period. This may be more than three months if due to an agency error. If the Department simply failed to act promptly on the information already received, benefits are retroactive to the date eligibility would have been established had the Department acted in a timely manner.