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West Virginia Income Maintenance Manual Chapter 22

West Virginia Income Maintenance Manual Page 33 Chapter 22 West Virginia Children’s Health Insurance Program (WVCHIP)

• Accept the backdated coverage for any period for which the child was eligible. • Begin the coverage at a later time, if there are not incurred medical expenses for the past period. Once an option is chosen and the AG is approved, the beginning date of eligibility cannot be changed. Delay in Processing Example: A client applies for WVCHIP for her children. Her application is received in the local office on September 4 and placed in the client’s file instead of being processed. The client calls on October 20 to check the status of her application. On October 21, the application, date-stamped September 4, is found in the file and processed. The client has the option of accepting 12-months of coverage beginning in either September, October, or November. Because the children incurred no medical expenses for September, she chooses to begin coverage in October. The 12- months of coverage begins in October and ends in September of the following year. After approval, the 12-month eligibility period cannot be changed. Spenddown Example: On December 15, 2013, a child’s family applies for Medicaid and the child is ineligible for all Medicaid coverage groups except AFDC-Related Medicaid. There is a $3,000 spenddown. Allowable bills equal to or greater than $3,000 must be provided to meet the spenddown by January 14, 2014, to be eligible for Medicaid. All other verifications and information necessary to determine eligibility is provided by the client on January 1. Bills in the amount of $2,345 were submitted on January 10, 2014 and failed to establish Medicaid financial eligibility. All requirements for WVCHIP were met January 1; therefore, coverage begins February. 22.16.4.D Relationship Between WVCHIP and Medicaid Coverage Groups An individual cannot receive both program benefits at the same time. If the child is eligible for Medicaid, he must enroll in Medicaid. Both programs provide healthcare benefits, but services and/or amount of services differ. Certain medical providers will accept only one program’s enrollees but not the others. An individual must first be determined ineligible for a MAGI Medicaid coverage group before he can receive WVCHIP. If the applicant chooses to pursue eligibility for a non-MAGI Medicaid coverage group while enrolled in WVCHIP and is found to be eligible for a non-MAGI Medicaid coverage group, the applicant is no longer eligible for WVCHIP; see Section 23.8. The WVCHIP eligibility must be closed after advance notice.