Page 1876
West Virginia Income Maintenance Manual Chapter 23
West Virginia Income Maintenance Manual Page 34 Chapter 23 Specific Medicaid Requirements
23.10.9.B.2 Beginning Date of Phase II Coverage An AG is eligible for Phase II coverage beginning the first month after Phase I coverage ends. When Phase II coverage is, in error, not begun in the correct month, coverage begins upon discovery of the error and is backdated to the date coverage should have begun. In no instance is Phase II coverage extended beyond six months past the end of Phase I coverage. 23.10.9.B.3 Client’s Reporting Requirements The client is required to report his gross earnings, the gross earnings of other Income Group adults in the home, and actual out-of-pocket day care costs. This information is used to determine financial eligibility for Phase II coverage. The PRL3 is mailed by the third Friday of the third month and must be completed and returned by the first workday after the 20th of the fourth month, unless the client establishes good cause. The PRL8 is mailed by the third Friday of the six month and the completed form is due by the first workday after the 20th of the seventh month. The PRL9 is mailed by the third Friday of the 9th month and the completed form is due by the first workday after the 20th of the 10th month. All PRL forms must be returned by the due date, unless the client establishes good cause. The Worker and Supervisor make the good cause determination, which must be based on reasonable expectations. Good cause generally will involve situations over which the client has little control. The Worker must file the PRL forms in the case record. An eligibility system alert notifies the Worker that the forms are due. 23.10.9.B.4 Automatic Termination of TM The eligibility system will automatically terminate TM eligibility at the end of eighth month if the PRL8 is not returned by the due date. The eligibility system will automatically terminate TM at the end of the eleventh month if the PRL9 is not returned by the due date.