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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 163 Chapter 1 Application/Redetermination Process

1.14.3 AGENCY TIME LIMITS The Worker must enter the State Data Exchange (SDX) information for approval within 45 days of the date on which the client first appears on data exchange, or the referral from SSA or the BMS Buy-In Unit is received. 1.14.4 PAYEE The SSI recipient is the payee, unless the use of a substitute payee is justified. 1.14.5 BEGINNING DATE OF ELIGIBILITY When the data exchange is used to approve the Medicaid AG, the beginning date of SSI Medicaid eligibility is established as follows: • SSI Medicaid eligibility begins with the first month for which an SSI payment is made. This is either the month after the month of application for SSI or the month following the month in which SSI eligibility is established. The beginning date of eligibility is based on the age of the individual. The date is determined by the following: o Age 21 or over – The beginning date of eligibility is the Medicaid effective date on data exchange. o Under age 21 –The beginning date of eligibility is the month prior to the month of the Medicaid effective date on data exchange. • If the individual has past medical bills, his eligibility begins up to three months prior to the month of the first SSI payment. Past medical bills are indicated on the SDX file and the Medicaid effective date on data exchange reflects this for backdated Medicaid coverage. When documentation other than data exchange is used to approve the Medicaid AG, the beginning date of SSI Medicaid eligibility is established as follows: • If the document used for verification gives the beginning date of SSI payment, but does not indicate if any back medical bills exist, the client must be questioned about any unpaid medical bills incurred during the 3 months prior to that date. If he has unpaid bills, coverage is backdated to the earliest of the 3 months in which the bills were incurred. If