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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 144 Chapter 24 Long Term Care

• The Worker updates financial eligibility. o If TBI waiver financial eligibility was determined in the last 90 days and is in pending status, the Worker updates the system and approves Medicaid TBI waiver program eligibility. o If more than 90 days have passed since financial eligibility was determined, the client must be reevaluated for financial eligibility. The Medicaid TBI waiver is not approved. The client must submit a new application prior to the expiration date on the white form. • The Worker checks the appropriate box on the white DHS-2.FRM indicating whether the client is eligible or ineligible for Medicaid TBI waiver and faxes the form back to the originating agency. • 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. TBI Application Example: Mr. Beech applies for the TBI waiver, which requires a medical eligibility decision by the TBI waiver program and a financial determination by an Income Maintenance Worker. While his medical eligibility decision is pending, he visits his local DOHS office and applies for the Supplemental Nutrition Assistance Program (SNAP). Although his medical eligibility for the TBI waiver has not been determined and a financial determination cannot be made by the Worker for the TBI waiver, his pending status for this program does not prevent his evaluation for all other Medicaid groups or DFA programs for which he may qualify. 24.45.3 WAIVER APPLICANTS CURRENTLY RECEIVING MEDICAID PAYMENT FOR NURSING FACILITY SERVICES For TBI waiver applicants currently receiving Medicaid payment for nursing facility services, the following steps are used. NOTE: When the applicant’s eligibility for, or enrollment in, this program is pending, due to the lack of a waiver slot or other reason, he must not be refused the right to apply due to his pending status for the TBI waiver group, but must be evaluated for any or all DFA programs.