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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 135 Chapter 1 Application/Redetermination Process

The Authorized Employee must assist the applicant or his AR in completing the single streamlined application (SLA) for Medicaid and forward the application to the Department. If the applicant or his AR is unable or unwilling to complete the full Medicaid application at that time, the Authorized Employee will explain to the patient or AR the different options for completing the SLA. If the applicant indicates he would like to complete his application via telephone, the Authorized Employee must have him contact the call center at 1-877-716-1212. The Authorized Employee should explain that he must call this number because he will be required to give a recorded telephonic signature. ➢ DOHS Worker Responsibilities Upon receipt of a completed PE application, which should include the PE Medicaid ID, the DOHS Worker begins processing the application. This process combines the two applications together and closes the PE period upon approval or denial of the Medicaid application. The Worker must establish whether the client was eligible at the time of the PE determination, as well as ongoing Medicaid eligibility. Income is verified by the same method as any other application. Medicaid eligibility begins on the first day of the month of the PE determination. Retroactive backdating is allowed with the Medicaid application, if the client is eligible. The DOHS Worker or the Qualified Provider must take the BMS-approved PE training and receive certification prior to becoming an Authorized Employee that will be permitted to take application for Presumptive Eligibility. The facility at which the DOHS Worker is placed will have agreed to accept responsibility for all decisions and outcomes of the DOHS Authorized Employee. The DOHS Worker that is at the facility will follow the same procedures for taking Presumptive Eligibility applications as any other PE worker. 1.6.11.C Changing Coverage Groups and Redetermination Period When one coverage group is closed and another opened, the AG may be assigned a new certification period. 1.6.11.D Spenddown Spenddown applies to SSI-related and AFDC–related coverage groups only.