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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 172 Chapter 1 Application/Redetermination Process

1.16.5 DUE DATE OF ADDITIONAL INFORMATION When the client visits the office and an interview is conducted, the Worker and client decide on a reasonable time for the client to return the information. When the client mails the application or completes the application in WV PATH or the Marketplace, the Worker then uses the verification checklist or form DFA-6 to inform the client of additional information needed. The client must be given at least 10 days after the date the verification checklist or DFA-6 is mailed to return the information. If the client does not return the DFA-QSQ-1 within 31 days from the date the eligibility system received the LIS file, the eligibility system sends a denial notice. No action is required by the Worker. Additional Information Example 1: Ms. Maple’s LIS data file is received by the eligibility system on August 2, 2010. She has no history of benefits with the Department. The next business day, the eligibility system issues a DFA-QSQ-1. Ms. Maple does not return the form. The eligibility system automatically denies the application and notifies Ms. Maple. Additional Information Example 1.2: Same as above. Ms. Maple’s DFA-QSQ-1 is received in the local office on August 16, 2010 and her application is approved for QMB. 1.16.6 AGENCY TIME LIMITS Eligibility system action to approve, deny or withdraw the application must be taken within 30 days of the date of application. For applications initiated from the LIS/MPA data exchange, action must be taken within 30 days of the date the file is received by the eligibility system. When LIS files indicate an individual is not currently eligible for Medicare but will receive it in a future month beyond the allowable processing time for MPA applications, the Worker must deny the application. However, if this individual reapplies within three months of the date he began receiving Medicare and was previously denied MPA for the sole reason of being approved for, but not yet receiving Medicare, his reapplication must be considered as a request for backdated coverage. All other policy related to MPA and backdated coverage applies.