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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 89 Chapter 24 Long Term Care

24.13 SPECIAL PROCEDURES RELATED TO COVERAGE GROUPS Individuals already receiving full coverage Modified Adjusted Gross Income (MAGI) Medicaid, who become eligible for Medicaid payment of nursing facility services, must be dually coded in the data system as receiving nursing home coverage. 24.13.1 SUPPLEMENTAL SECURITY INCOME (SSI) RECIPIENTS The Worker must notify the Social Security Administration (SSA) using the DFA-HS-3 when the SSI recipient enters or leaves a nursing facility. When the institutionalized SSI recipient has an Essential Spouse (See Chapter 23) who is included in the assistance group (AG) and who appears on the same Medical ID card, the Essential Spouse remains eligible for SSI Medicaid, unless the State Data Exchange (SDX) information indicates the SSI is terminated. The Worker must use appropriate procedures to provide Medicaid to the nursing facility client and the Essential Spouse. 24.13.2 DEEMED SSI RECIPIENTS Deemed SSI recipients can be Medicaid clients even though they do not receive SSI. When the Deemed SSI recipient enters a nursing facility and is eligible for payment for his care, his coverage group does not change.