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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 10 Chapter 24 Long Term Care

to factors beyond the control of the DOHS, the client is eligible to receive direct reimbursement for out-of-pocket medical expenses. See Chapter 10. 24.4.1.C.8 Payee The client is the payee. 24.4.1.C.9 Repayment and Penalties This does not apply to the Nursing Facility coverage group and SSI-Related/Monthly Spenddown Medicaid. 24.4.1.C.10 Beginning Date of Eligibility ➢ Medicaid Eligibility Medicaid eligibility begins on the first day of the month in which eligibility is established. Eligibility may be backdated up to three months prior to the month of application, when all eligibility requirements were met, and the client has medical expenses for which he seeks payment. ➢ Payment for Nursing Facility Services Payment for nursing facility services begins on the earliest date the three conditions described below are met simultaneously. Payment for nursing facility services may be backdated up to three months prior to the month of application when all the conditions described below are met for that period. • The client is eligible for Medicaid; and • The client resides in a Medicaid-certified nursing facility; and • There is a valid pre-admission screening (PAS) or, for backdating purposes only, physician’s progress notes or orders in the client’s medical records. Section 24.12 contains information about the PAS and details specific situations in which the progress notes or orders are used.