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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 132 Chapter 1 Application/Redetermination Process

• Accept the electronic account for the client who is assessed by the Marketplace as potentially eligible for a non-MAGI group, or when the client requests a full determination. • Notify the Marketplace of receipt of the electronic account. • Not request additional information or verifications from the client already verified electronically. • Promptly determine eligibility without requiring another application; ensure timeliness standards in this chapter are met. • Notify the Marketplace of the final eligibility determination. 1.6.11.A.2 Applications Taken by DOHS The Worker determines eligibility for MAGI Medicaid and WVCHIP groups. Non-financial and financial information about the applicant is matched by the FDH in real time. ➢ DOHS Determines Eligibility for a MAGI Coverage Group When the Department determines the client is eligible for Medicaid or WVCHIP based on MAGI, the Department must: • Promptly enroll the applicant into the MAGI coverage group. The client may also pursue eligibility for non-MAGI Medicaid coverage groups while enrolled in the MAGI group. ➢ DOHS Determines Applicant Not Eligible for a MAGI Coverage Group When the Department determines the applicant is not eligible for Medicaid or WVCHIP based on MAGI, the Department must: • Promptly determine potential eligibility for APTC/CSR and transfer the applicant’s electronic account to the Marketplace; and • Certify for the Marketplace the criteria applied in determining eligibility; and • Provide the applicant with a combined eligibility notice, including notice of the Medicaid denial or closure, transfer of their electronic account to the Marketplace, and fair hearing rights. The DOHS does not determine eligibility for the Marketplace’s benefits but may refer individuals to an in-person assistor or Navigator for assistance.