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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 133 Chapter 1 Application/Redetermination Process

When an individual is ineligible for MAGI Medicaid or WVCHIP due to income, and he attests to disability, he may be eligible for an SSI-Related, Medicaid Work Incentive Network (M-WIN) or other Medicaid Group. During this time, he may receive Marketplace benefits. If approved for other non-MAGI Medicaid coverage, the Marketplace is electronically notified. When the Department determines the applicant is not eligible for Medicaid or WVCHIP based on MAGI, but are completing a determination for a non-MAGI coverage group, the Department must: • Promptly determine potential eligibility for APTC/CSR and transfer the client’s electronic account to the Marketplace. • Provide notice to the Marketplace that the client is not Medicaid or WVCHIP eligible based on MAGI, but that a final determination based on non-MAGI is pending. • Provide notice to the client in simple language that the Department determined them ineligible for Medicaid or WVCHIP based upon MAGI standards but are continuing to evaluate them for coverage for non-MAGI coverage groups. • Provide coordinated content in the notice including that the client’s account was transferred to the Marketplace for an evaluation for APTC/CSR, and that enrollment in APTC/CSR will not affect their potential Medicaid eligibility. • Provide the client notice of the final non-MAGI Medicaid eligibility determination and fair hearing rights. If the client is determined eligible for a non-MAGI coverage group, the notice should inform the client that the Marketplace will be notified of the client’s eligibility, and that Medicaid eligibility will result in closure of APTC/CSR. • Notify the Marketplace of the final eligibility determination based on non-MAGI. 1.6.11.A.3 Coordination between DOHS and the Marketplace Involving Appeals The Department must establish a secure electronic interface so that: • The Marketplace can notify the Department when an applicant has requested a fair hearing; and • The applicant’s electronic account, including information provided as part of the appeal, can be transferred between the Department and the Marketplace. When conducting a fair hearing, the Department should not request information or documentation from the applicant that is already included in their electronic account. The Department must transmit to the Marketplace the hearing decision made by the Department.