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West Virginia Income Maintenance Manual Chapter 23

West Virginia Income Maintenance Manual Page 32 Chapter 23 Specific Medicaid Requirements

continued beyond the month ineligibility occurs because of an agency or client error, the beginning date of TM is the first month after advance notice would have expired and the client should have lost eligibility. 23.10.9.A.6 Client’s Reporting Requirements/Periodic Review Letters The client is required to report his gross earnings and day care costs for the first three months of Phase I coverage by the first workday after the 20th of the fourth month. He is also required to report the earnings and day care costs of any person in the home who is included in the Parents/Caretaker Relatives Medicaid Income Group. In addition, he must report his gross earnings and day care costs for the last three months of Phase I coverage by the first workday after the 20th of the first month of Phase II coverage. The client reports using Periodic Review Letters. The periodic review letter dates throughout this section will vary due to adverse action deadline and non-workdays. See Appendix A. The eligibility system mails the client the first required periodic review letter by the third Friday of the third month. If the client returns the completed letter, he has met one of the eligibility requirements for Phase II coverage. Failure to return the completed letter, without good cause, by the first workday after the 20th of the fourth month, automatically renders the AG ineligible to participate in Phase II, after advance notice, but has no effect on Phase I coverage. The Worker must notify the client of the consequences of his actions when the letter is not returned by the due date without good cause or is returned but is incomplete. The client has a right to a Fair Hearing on this issue because future eligibility is involved. The Worker must not wait until the end of Phase I coverage to notify the client of his ineligibility for Phase II. The process of determining eligibility or ineligibility, based on this reporting requirement, is completed prior to the end of Phase I coverage. The Worker and Supervisor make the good cause determination and must be based on reasonable expectations. Good cause generally will involve situations over which the client has little control. The eligibility system notifies the Worker when the form is due. If the client provides the completed form within the 13-day notice period, he has met this part of the eligibility requirement for Phase II.