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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 131 Chapter 1 Application/Redetermination Process

• If the individual is over income for MAGI Medicaid or WVCHIP, evaluate him for the insurance affordability programs, Advance Premium Tax Credits and Cost Sharing Reductions (APTC/CSR). ➢ Marketplace Determines Eligibility for a MAGI Coverage Group When the Marketplace determines the applicant is eligible for a MAGI coverage group, the DOHS must: • Accept electronic accounts transferred from the Marketplace for clients determined Medicaid or WVCHIP eligible based on MAGI. • Promptly complete enrollment into the correct Medicaid or WVCHIP coverage group. • Not request any additional information or verifications from the client. • Provide additional notification of enrollment to the client, including benefits available. ➢ Marketplace Determines Potential Eligibility for a MAGI Coverage Group When the Marketplace determines the applicant is potentially eligible for a MAGI coverage group, the DOHS must: • Accept the electronic account for the client who is assessed by the Marketplace as potentially eligible for a MAGI group • Notify the Marketplace of receipt of the electronic account • Not request additional information of verifications from the client already verified electronically • Conduct any additional verifications that may be required • Promptly determine eligibility without requiring another application; ensure timeliness standards in this chapter are met • Notify the client and the Marketplace of the final eligibility determination ➢ Marketplace Determines Potential Eligibility for a Non-MAGI Coverage Group When the Marketplace determines the client is potentially eligible for a non-MAGI coverage group, the Department must: