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West Virginia Income Maintenance Manual Chapter 22

West Virginia Income Maintenance Manual Page 34 Chapter 22 West Virginia Children’s Health Insurance Program (WVCHIP)

22.16.4.E Long Term Care If the child requires long-term care services and qualifies for an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), Aged and Disabled Waiver (ADW), Children with Disabilities Community Service Program (CDCSP), or Intellectually/Developmentally Disabled (I/DD) Waiver coverage groups, the child is then eligible for full coverage Medicaid and ineligible for WVCHIP. WVCHIP does not qualify an individual for Medicaid payment of long-term care services, and long-term care services are not covered WVCHIP services. 22.16.5 CREDITABLE (NON-EXCEPTED) HEALTH INSURANCE When the Worker receives an application showing that the family has non-excepted health insurance (see Appendix A), he must determine if the client is otherwise eligible for WVCHIP, except for having current non-excepted health insurance coverage prior to denial.

When the Worker receives an application without non-excepted health insurance listed, and the client is determined otherwise eligible for WVCHIP, a request is submitted by the eligibility system to the BMS Third Party Insurance Verification Vendor to look for non-excepted health insurance coverage information. See Section 22.7.

• If non-excepted health insurance information is returned, WVCHIP must be denied. • In no information is returned, the WVCHIP can be approved.

If proof is submitted that insurance is dropped, WVCHIP eligibility can start without penalty the month after the insurance is no longer in effect, and without the need for a new application as long as the current application is not older than 60 days. 22.16.6 WVCHIP PREMIUM PAYMENT The premium amount is based on the number of children in the family approved for WVCHIP Premium coverage. The premium amount for one child is $35 per month. The premium amount