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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 94 Chapter 24 Long Term Care

INTERMEDIATE CARE FACILITIES/INDIVIDUALS WITH INTELLECTUAL DISABILITIES 24.16 APPLICATION/REDETERMINATION If the client is currently enrolled in, or eligible for, full-coverage Medicaid, he must still be assessed for medical eligibility. If found eligible, the client must be assessed to determine if he must contribute to his cost of care. These clients, including Supplemental Security Income (SSI) and Deemed SSI recipients, must complete the DFA-LTC-5 at application and annual redetermination for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) to evaluate any annuities, trusts, and/or other potential resources or transfers unless they meet any listed exceptions. See Section 24.1. If the client is not eligible for full-coverage Medicaid, he may be eligible the ICF/IID group if he meets certain income and asset standards. These applicants, including Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLIMB), and Qualified Individual – 1 (QI-1) clients, must complete the full application process. See Section 24.7. If found eligible, the client must contribute toward his cost of care. If the client is not otherwise eligible, eligibility as an SSI-Related Medicaid client must be explored. The application/redetermination process is the same as SSI-Related Medicaid, with the following exceptions that govern time limits on processing the application: • As a result of the Medley, et al. vs Lipscomb court order, the Department of Human Services (DOHS) is required to determine an individual's eligibility for ICF/IID level of care and placement in a ICF/IID facility within three working days of receiving a completed application. Presumptive eligibility is determined using a DFA-ICF/MR-1. The case management agency, in conjunction with the admission committee from the certified ICF/IID facility, is responsible for determining the initial financial eligibility. This presumptive eligibility period may not exceed 30 days. The completed DFA-ICF/MR-1 is considered the initial application. • The DFA-ICF/MR-1 form must be date-stamped when received in the local office. The three-working-day time limit begins the day after the DCA-ICF/MR-1 is received. When the DFA-ICF/MR-1 form is received, the local office Community Services Manager (CSM) is responsible for: • Having the case entered and approved for presumptive eligibility in the eligibility system within this three-working-day time limit.