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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 130 Chapter 1 Application/Redetermination Process

Regardless of where the applicant submits their SLA, eligibility can be determined for insurance affordability programs including MAGI coverage groups based on the information collected on the application without requiring additional action by the applicant. 1.6.11.A.1 Applications Taken by the Marketplace West Virginia entered into an agreement with the FFM whereby the Department will accept as final the Medicaid and WVCHIP eligibility determinations made by the Marketplace based on MAGI. The Marketplace determines eligibility for MAGI Medicaid groups and WVCHIP only, in real time without delay when possible. Non-financial and financial information about the applicant is matched with the Federal Data Hub (FDH). When completing the eligibility determination for an applicant that submits an SLA to the Marketplace, the Marketplace must: • Accept the SLA; • Check for existing Medicaid or WVCHIP coverage; • Verify citizenship/immigration status, residency, incarceration status, current monthly income and annual income; • Apply the reasonable compatibility standard and reconcile any differences; • Apply West Virginia’s state eligibility rules; • Complete the eligibility determination; • Provide appropriate notices, fair hearing rights, and communications to the client; • Transfer the eligible client’s electronic account to the Department, without delay; • Transfer applications to the Department for applicants requesting a full determination of Medicaid on a basis other than MAGI; and, • Transfer to the Department for a full eligibility determination, without delay, the electronic account of a client that indicates on their application potential eligibility for a non-MAGI coverage group. NOTE: The SLA does not provide sufficient information for the Department to determine eligibility for non-MAGI coverage groups. If the client indicates potential eligibility for a non- MAGI coverage group, the Department must provide the client with the DFA-SLA-S1 to obtain the additional information needed to determine eligibility. See Section 23.8.2 for information regarding determining eligibility between MAGI and non-MAGI coverage groups.