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West Virginia Income Maintenance Manual Chapter 23

West Virginia Income Maintenance Manual Page 30 Chapter 23 Specific Medicaid Requirements

23.10.9.A.2 Loss of Eligibility Before Expiration of Full Phase I Coverage The following circumstances result in case closure (after advance notice) before the expiration of the Phase I coverage. There is no provision to discontinue Phase I coverage for failure of the parent to continue working. ➢ No Dependent Child

When there is no child in the home who would be eligible for Medicaid, the AG loses eligibility. Eligibility ends at the end of the first month in which the AG no longer includes such a child. No Dependent Child Example: Last dependent child leaves the home on February 10. The case is closed effective February. Advance notice is required.

➢ Fraud

When it is determined that Parents/Caretaker Relatives Medicaid benefits received in one or more of the six months prior to the start of Phase I coverage were received fraudulently, the AG is ineligible. Eligibility ends on the last day of the month in which the advance notice period expires. ➢ Enrollment in Free Employer’s Plan

When the person whose employment caused ineligibility for Parents/Caretaker Relatives Medicaid does not enroll or maintain enrollment in the employer's health plan, provided such coverage is free to the client, the AG becomes ineligible. Eligibility ends on the last day of the month in which the advance notice period expires. Benefits are not delayed pending compliance with this requirement. The client must be allowed 30 days to prove he has taken the steps necessary to comply. 23.10.9.A.3 Eligible Situations Provided the AG meets all of the eligibility requirements identified above, it is eligible for Phase I TM in the following situations: