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West Virginia Income Maintenance Manual Chapter 24
West Virginia Income Maintenance Manual Page 11 Chapter 24 Long Term Care
➢ Examples Expired PAS Example: Mr. Birch is a patient in a hospital. The physician recommends nursing facility care to Mr. Birch’s family and completes a PAS dated June 5, 2016. The family is undecided about placing Mr. Birch in a nursing facility and takes him home to provide care. They do not apply for Medicaid until August 16, 2016, which is the date Mr. Birch enters the nursing facility. Medicaid eligibility is established beginning August 1, 2016. The original PAS has expired. A new PAS is not completed until August 22, 2016. The Worker can request the physician’s notes to verify Mr. Birch’s medical necessity from August 16, 2016, through August 22, 2016. Medicaid nursing care payments begin August 16, 2016 using physician’s notes. Delayed Entry Example: Same situation as above except that the PAS is dated June 25, 2016. A new PAS is not required, but nursing facility payments cannot begin until August 16, 2016, which is the date Mr. Birch entered the nursing facility. Excess Assets Example: Ms. Dahlia enters a nursing facility on August 16, 2016, and the PAS is signed August 16, 2016. However, she does not become Medicaid eligible until September 1, 2016, due to excess assets. Payment for nursing facility services begins September 1, 2016. Backdating Example: Mr. Pine enters a nursing facility on October 10, 2016, and a PAS is signed on that date. On November 25, 2016, his family applies for Medicaid to pay for his nursing care costs. Medicaid eligibility is backdated to August 1, 2016, to cover the cost of his recent hospitalization. Payment for nursing facility services begins on October 10, 2016. 24.4.1.C.11 The Benefit A Medical ID card is issued for each eligible individual. ➢ Ongoing Benefits Effective December 21, 2017 there was a change in the way Medical ID cards are issued. Instead of the separate blue paper card, the Medical ID card is now included in all Medicaid approval notices. The Medical ID card does not include any date parameters since eligibility may terminate.