Page 1818
West Virginia Income Maintenance Manual Chapter 22
West Virginia Income Maintenance Manual Page 32 Chapter 22 West Virginia Children’s Health Insurance Program (WVCHIP)
22.16.4.B Certificate of Coverage When WVCHIP Coverage Ends The Worker is not required to issue a DFA-HIP-1, Certificate of Medical Coverage, to the family. 22.16.4.C Backdating Coverage The policy that allows Medicaid coverage to be backdated up to three months prior to the date of application does not apply to WVCHIP benefits. Only the following situations require the Worker to backdate WVCHIP coverage: • A newborn was born on or after the 21st of the month and the application for that child is not submitted until the following month. The Worker must backdate eligibility to include the first day of the birth month; Newborn Backdating Example 1: The baby is born April 27 and the application is submitted May 13. Coverage should be backdated to April to include the baby's birth. Newborn Backdating Example 2: The baby is born on May 15 and the application is submitted June 2. Coverage will not be backdated to May to include the birth month. • Failure of the Worker to request additional information in a timely manner and the delay results in a loss of coverage; • Failure of the Worker to approve a complete application within 13 business days of receipt and the delay results in a loss of coverage; • Inability of the Worker to approve coverage beginning the first of the following month when the applicant applies and/or establishes eligibility too late in the month, and the data system deadline for next month approval has passed; • At the request of WVCHIP administration; or • When a redetermination cannot be completed automatically and the client does not provide the additional information requested within 30 days, the benefit is closed. If the client provides the information within 90 days of the effective date of closure, the agency will determine eligibility in a timely manner without requiring a new application. If the client is found eligible, the coverage must be reinstated to the effective date of closure. When approval is delayed due to Worker error and results in eligibility for backdated coverage, the client must be given the following options: