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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 173 Chapter 1 Application/Redetermination Process

Time Limit Example 1.1: Mr. Birch's LIS/MPA file is received April 3 and indicates he will not receive Medicare until August. In order to comply with MPA processing time limits, the Worker must deny the MPA. Mr. Birch reapplies for MPA at the local office in September. The Worker must consider this application as including a request for backdated benefits to the month he began receiving Medicare and approves SLIMB effective August. Time Limit Example 1.2: Same as above, except Mr. Birch reapplies for SLIMB in December. If he requests backdated MPA, his SLIMB application is treated like any other and can be approved effective September. 1.16.7 AGENCY DELAYS When the Department fails to request necessary verification, the Worker must immediately send the eligibility system verification checklist or form DFA-6 to request it. He must inform the client that the application is being held pending. When the verification is received and the client is eligible, medical coverage is retroactive to the date eligibility would have been established for QMB, SLIMB or QI-1. When the QMB, SLIMB or QI-1 application is not processed within agency time limits, the application must be processed immediately upon discovery of the delay. QMB, SLIMB and QI-1 cases must have the eligibility period backdated. Agency Delay Example: Ms. Willow applies for LIS at the SSA on October 26, 2016 and expresses an interest in MPA. This is her LIS/MPA application date. She returns her DFA-QSQ-1 with all verifications on October 29, 2010, but they are misplaced. The Worker takes corrective action in December 2016 and notes the LIS application date in October. Since the client was otherwise eligible in October, the Worker backdates the QMB with a beginning eligibility date of November 2016. The QMB client is eligible to receive direct reimbursement for out-of-pocket medical expenses if the Department has not acted on the application within a reasonable period of time. See Chapter 10. 1.16.8 PAYEE