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West Virginia Income Maintenance Manual Chapter 23

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

23.10.4 ADULT GROUP Income Assets 133% FPL N/A As a result of the ACA, the Adult Group was created effective January 1, 2014. Eligibility for this group is determined using Modified Adjusted Gross Income (MAGI) methodologies established in Section 4.7. Medicaid coverage in the Adult Group is provided to individuals who meet the following requirements: • They are age 19 or older and under age 65; • They are not eligible for another categorically mandatory Medicaid coverage group: o SSI o Deemed SSI o Parents/Caretaker Relatives o Pregnant Women o Children Under Age 19 o Former Foster Children • They are not entitled to or enrolled in Medicare Part A or B; and • The income eligibility requirements described in Chapter 4 are met. Parents or other caretaker relatives living with a dependent child under the age of 19 are not eligible for Medicaid in the Adult Group unless the child is receiving benefits under Medicaid, WVCHIP, or otherwise enrolled in minimum essential health coverage (MEC). 23.10.4.A.1 Pregnant Women If a woman indicates at application that she is pregnant, she is not eligible to be included in the Adult Group; she must be evaluated for the Pregnant Women coverage group. If a woman currently receiving Medicaid in the Adult Group later reports a pregnancy to the Department of Human Services (DOHS), follow instructions in Section 10.8.4. However, there is no requirement for a woman to report her pregnancy to the DOHS.

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Page 1865

Official source

West Virginia Income Maintenance Manual Chapter 23

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

23.10.4 ADULT GROUP Income Assets 133% FPL N/A As a result of the ACA, the Adult Group was created effective January 1, 2014. Eligibility for this group is determined using Modified Adjusted Gross Income (MAGI) methodologies established in Section 4.7. Medicaid coverage in the Adult Group is provided to individuals who meet the following requirements: • They are age 19 or older and under age 65; • They are not eligible for another categorically mandatory Medicaid coverage group: o SSI o Deemed SSI o Parents/Caretaker Relatives o Pregnant Women o Children Under Age 19 o Former Foster Children • They are not entitled to or enrolled in Medicare Part A or B; and • The income eligibility requirements described in Chapter 4 are met. Parents or other caretaker relatives living with a dependent child under the age of 19 are not eligible for Medicaid in the Adult Group unless the child is receiving benefits under Medicaid, WVCHIP, or otherwise enrolled in minimum essential health coverage (MEC). 23.10.4.A.1 Pregnant Women If a woman indicates at application that she is pregnant, she is not eligible to be included in the Adult Group; she must be evaluated for the Pregnant Women coverage group. If a woman currently receiving Medicaid in the Adult Group later reports a pregnancy to the Department of Human Services (DOHS), follow instructions in Section 10.8.4. However, there is no requirement for a woman to report her pregnancy to the DOHS.