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West Virginia Income Maintenance Manual Chapter 23

West Virginia Income Maintenance Manual Page 31 Chapter 23 Specific Medicaid Requirements

• The AG was eligible for and receiving Parents/Caretaker Relatives Medicaid and the beginning of employment or change in payment rate had an effect on Parents/Caretaker Relatives ineligibility. • The earned income of an individual who received Parents/Caretaker Relatives Medicaid in three of the last six months, and who is added to the AG, has an effect on the AG’s Parents/Caretaker Relatives Medicaid ineligibility. • The case becomes ineligible for Parents/Caretaker Relatives Medicaid due to failure to report or provide verification of new earnings, provided that fraud is not indicated. • The case becomes ineligible for one month only due to a temporary increase in hours worked or rate of pay. 23.10.9.A.4 Ineligible Situations The AG is not eligible for Phase I coverage in the following situations: • The AG becomes ineligible because of the earnings of an individual being added to the AG who has not received Parents/Caretaker Relatives Medicaid in three of the last six months. • The AG becomes ineligible for a reason other than those listed above. • There is an indication, with supporting evidence, that the AG received Parents/Caretaker Relatives Medicaid fraudulently during at least one of the six months prior to the first month of Parents/Caretaker Relatives Medicaid ineligibility. The Worker must determine from the case record if a referral has been made to Investigations and Fraud Management (IFM) or if an IFM decision has been rendered on any fraud claim. If there is a substantive indication that fraud was involved, the AG is not eligible for Phase I coverage. There is no provision to discontinue Phase I coverage due to the AGs becoming eligible for Parents/Caretaker Relatives Medicaid again. Instead, the AG is dually eligible for Parents/Caretaker Relatives Medicaid and TM. See below for the significance of dual eligibility. 23.10.9.A.5 Beginning Date of Phase I Coverage An AG is eligible for Phase I coverage beginning the month following the last month of Parents/Caretaker Relatives Medicaid eligibility. When Parents/Caretaker Relatives Medicaid is