Page 2048

West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 123 Chapter 24 Long Term Care

If the client is determined financially ineligible for the ADW: • The Worker checks the box on the yellow DHS-2.FRM indicating the client is ineligible and faxes the form back to the UMC. • The Worker then evaluates for all other Division of Family Assistance (DFA) programs. The client will be sent a denial letter by the eligibility system. 24.37.2.B Step Two: Receipt of the DOHS Referral Form for Medicaid Aged and Disabled Waiver Program (DHS-2.FRM) WHITE FORM The white DHS-2.FRM, along with the Notice of Decision letter, confirms to the Worker the client was determined medically-eligible and awarded a funded slot for the ADW program. The white DHS-2.FRM originates from a case management agency if the client chooses the traditional service delivery model, or from the Bureau of Senior Services (BoSS) if the client chooses the personal options delivery model. 24.37.2.B.1 Expired White DHS-2.FRM If the white DHS-2.FRM form is expired, the Worker checks the box indicating it is expired and faxes the form back to the originating agency. Medicaid is not approved. 24.37.2.B.2 White DHS-2.FRM with Missing Expiration Date If there is no expiration date on the white DHS-2.FRM, it should be faxed back to the originating agency, noting there is no expiration date. Medicaid is not approved. 24.37.2.B.3 Current (Not Expired) White DHS-2.FRM If the white DHS-2.FRM is not expired: • The Worker updates financial eligibility.

loading…

Page 2048

Official source

West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 123 Chapter 24 Long Term Care

If the client is determined financially ineligible for the ADW: • The Worker checks the box on the yellow DHS-2.FRM indicating the client is ineligible and faxes the form back to the UMC. • The Worker then evaluates for all other Division of Family Assistance (DFA) programs. The client will be sent a denial letter by the eligibility system. 24.37.2.B Step Two: Receipt of the DOHS Referral Form for Medicaid Aged and Disabled Waiver Program (DHS-2.FRM) WHITE FORM The white DHS-2.FRM, along with the Notice of Decision letter, confirms to the Worker the client was determined medically-eligible and awarded a funded slot for the ADW program. The white DHS-2.FRM originates from a case management agency if the client chooses the traditional service delivery model, or from the Bureau of Senior Services (BoSS) if the client chooses the personal options delivery model. 24.37.2.B.1 Expired White DHS-2.FRM If the white DHS-2.FRM form is expired, the Worker checks the box indicating it is expired and faxes the form back to the originating agency. Medicaid is not approved. 24.37.2.B.2 White DHS-2.FRM with Missing Expiration Date If there is no expiration date on the white DHS-2.FRM, it should be faxed back to the originating agency, noting there is no expiration date. Medicaid is not approved. 24.37.2.B.3 Current (Not Expired) White DHS-2.FRM If the white DHS-2.FRM is not expired: • The Worker updates financial eligibility.