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West Virginia Income Maintenance Manual Chapter 23

West Virginia Income Maintenance Manual Page 1 Chapter 23 Specific Medicaid Requirements

23.1 INTRODUCTION The West Virginia Medicaid Program provides payment for covered medical services to certified medical providers for eligible individuals, including adults, eligible members of families with dependent children, and those who are aged, blind, or disabled. The determination of which medical services are covered under Medicaid and which medical providers are certified to accept Medicaid patients is the responsibility of the Bureau for Medical Services (BMS) and is not addressed in this Manual. Unless otherwise specified, the coverage group receives all services covered under Medicaid and is considered “full Medicaid.” This chapter provides an overview of the Medicaid Program. In addition, each coverage group has specific requirements that must be met and procedures to follow that may not apply to other Income Maintenance programs or other Medicaid coverage groups. This includes income and asset criteria. No group is subject to a spenddown unless specifically noted. Information for West Virginia Children’s Health Insurance Program (WVCHIP) and AIDS Drug Assistance Program (ADAP) is also contained in this chapter. In addition to the coverage groups described in this chapter that make up the Medicaid Program, WVCHIP, and ADAP, the Department of Human Services (DOHS) has special procedures in place to pay for certain necessary drugs for individuals not eligible for other benefits. See Chapter 28, Special Pharmacy. Refer to Chapter 24 for information regarding eligibility for long-term care services, which include nursing facilities and intermediate care facilities for individuals with intellectual disabilities (ICF/IID) services and aged and disabled (ADW), traumatic brain injury (TBI) and intellectual and developmental disabilities (I/DD) waiver coverage groups, as well as Children with Disabilities Community Services Program (CDCSP). Certain programs, including long-term care programs, require a medical and/or other determination by a community agency or government organization other than the Division of Family Assistance (DFA) and a financial determination by an Income Maintenance Worker. When an applicant’s medical eligibility for, or enrollment in, these programs is pending, he must be evaluated for any or all DFA programs.