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West Virginia Income Maintenance Manual Chapter 22

West Virginia Income Maintenance Manual Page 23 Chapter 22 West Virginia Children’s Health Insurance Program (WVCHIP)

No application is required. Medicaid is approved for a new 12-months of continuous coverage. 22.11.2.C Updates in Assistance Group (AG) Information The case information in the eligibility system must be updated based on changes reported by the client and by other valid sources, even though the client is eligible for 12 continuous months of coverage. The Worker must evaluate changes made outside of the required annual redetermination cycle so that the child may be correctly evaluated for Medicaid. Any change in the family’s circumstances that could result in Medicaid eligibility for the child requires the Worker to reevaluate Medicaid eligibility. 22.11.2.D Pregnancy of a WVCHIP Client When the Worker is notified that the WVCHIP child is pregnant, the Worker must evaluate eligibility for Pregnant Woman Medicaid coverage. When a WVCHIP child becomes eligible for Medicaid as a Pregnant Woman, she may be determined Medicaid eligible as of the first day of the month of application, or up to three months prior to the month of application, provided all eligibility requirements were met. The client may choose the beginning date of eligibility and Medicaid eligibility may be established for the earliest month in which expenses not paid by WVCHIP were incurred. All case circumstances (including income, AG composition, marital status of the pregnant woman, etc.) are used as they existed in the month that the pregnant woman first met all Medicaid eligibility requirements. WVCHIP eligibility must be closed at the end of the month of the determination of Pregnant Woman coverage prior to opening any backdated coverage under Medicaid If the pregnant WVCHIP child is not found eligible for Medicaid, she remains on WVCHIP, which continues to pay for all services, including pregnancy services. The newborn is automatically eligible for WVCHIP. See Section 22.16.2. NOTE: See Section 22.16 for procedures regarding WVCHIP Premium coverage.