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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 147 Chapter 1 Application/Redetermination Process

1.9 MAGI PREGNANT WOMEN The Affordable Care Act (ACA) simplified eligibility categories by combining certain existing mandatory and optional eligibility groups. The Pregnant Women coverage group combines former Poverty-Level and Deemed Poverty-Level Pregnant Woman coverage groups. 1.9.1 WHO CAN BE INCLUDED ON THE SAME APPLICATION? • Individuals who have a familial relationship with the applicant (spouse, child - biological, adopted or stepchild; parent - biological, adopted or stepparent; sibling - biological, adopted, half or step sibling.) • Individuals who are a tax dependent of, or on the same income tax return with, the applicant. • Individuals who are under age 19 may be included on an application submitted by an adult application filer, even if the child and application filer are not in a familial or tax relationship. Adult individuals who do not fall into one of these categories will be notified that they must submit a separate application. 1.9.2 AGENCY TIME LIMITS Eligibility system action must be taken to approve the application within 13 business days of the date a completed application is received in the local office. If additional information or EXCEPTION: A non-custodial parent cannot apply for Medicaid or WVCHIP for their child even when claiming their child as a tax dependent. In this situation, based on MAGI rules, the child’s MAGI household includes - himself, his parents (biological, adopted or step parents), and siblings (biological, adopted or step) under 19 with whom he resides. Information necessary to determine the child’s eligibility cannot be determined based on the non-custodial parent’s application; therefore, the case should fail for the child with the reason that the non-custodial parent cannot apply for the child.