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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 127 Chapter 24 Long Term Care

The client has only 60 days after acquiring a waiver slot to establish eligibility and be enrolled in the waiver program, or they will lose their slot. Timely financial eligibility determinations are critical. 24.37.4 REDETERMINATION PROCESS A redetermination of eligibility is completed once a year; a face-to-face interview is not required. When possible, the redetermination process is completed automatically using electronic data matches without requiring information from the client. This redetermination process is initiated by the eligibility system, which matches current information with the Federal Data Services HUB and the Asset Verification System (AVS). If determined eligible after completing the redetermination process, the DoHS will notify the client. The notice will identify the information used to determine eligibility. If the customer agrees with the information, no further action is required. If the client does not agree, he is to report the information that does not match the circumstances. These changes will be treated as a change in circumstance during the certification period. If the automatic redetermination process is successful, the worker will receive a System Generated Alert to confirm continued medical eligibility and waiver enrollment. When the redetermination process cannot be completed automatically, the eligibility system alerts the worker when a redetermination is due and automatically sends a redetermination form to the client. The redetermination form is due by the first day of the 12th month of the certification period. If the redetermination form is not received by the adverse action date, the AG is issued a notice of closure. The Worker must manually set an alert to schedule the redetermination for SSI and Deemed SSI waiver clients. The same financial criteria used at application applies at each annual redetermination. Medical necessity must be verified annually at redetermination with a Notice of Decision letter or document from the UMC stating the client continues to be eligible. If the client continues to meet financial and medical requirements, Medicaid eligibility for waiver services is established. Continued medical eligibility for services is monitored by the Bureau for Medical Services (BMS).