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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 129 Chapter 1 Application/Redetermination Process

1.6.9 CLIENT NOTIFICATION The client must be informed that he is eligible for Medicaid coverage and the date that his coverage begins. Client notification is accomplished by the eligibility system, when the case is properly coded. The notification includes the beginning date of eligibility. See Chapter 9. 1.6.10 REPAYMENT AND PENALTIES Repayment and Penalties do not apply to the Medicaid application process. Repayment from the client is only pursued if intentional misrepresentation is established; see Section 11.4. See Section 2.4 for an explanation of requirements to cooperate with Quality Control (QC) if selected for a QC review. 1.6.11 SPECIAL SITUATIONS 1.6.11.A Coordination between DOHS and the Federally Facilitated Marketplace The Affordable Care Act (ACA) established standards and guidelines for ensuring a coordinated and timely process for performing eligibility determinations, for facilitating enrollment into coverage and for transferring the applicant’s information between the Department and the Federally Facilitated Marketplace (FFM or Marketplace). The Department must enter into an agreement with the Marketplace which outlines the responsibilities of each agency to ensure prompt determination of eligibility and enrollment in the appropriate insurance affordability program based on the date the single-streamlined application (SLA) is submitted to either the Department or the Marketplace. The Act also requires that no matter where the applicant submits the SLA, the Department or the Marketplace, they will receive an eligibility determination for any insurance affordability program and be able to enroll in the appropriate coverage, if eligible, without delay.