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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 145 Chapter 24 Long Term Care

24.45.3.A Step One: Receipt of the DOHS Referral Form for Medicaid Traumatic Brain Injury Waiver Program, Initiate Financial Eligibility (DHS-2.FRM) YELLOW FORM The yellow DHS-2.FRM instructs the Worker to determine financial eligibility. The Worker must first evaluate the client’s financial eligibility based on the current information in the case record. Clients currently receiving Medicaid payment for nursing facility services in the Nursing Facility coverage group, or as an SSI or Deemed SSI recipient, have been determined financially eligible and are not required to complete a new Medicaid application upon receipt of the yellow DHS-2.FRM. All other clients currently receiving Medicaid payment for nursing facility services must submit an appropriate waiver application form prior to the expiration date on the yellow DHS-2.FRM. 24.45.3.A.1 Expired Yellow DHS-2.FRM If the yellow DHS-2.FRM is expired, the Worker checks the box indicating it is expired and faxes the form back to the TBI waiver UMC. 24.45.3.A.2 Yellow DHS-2.FRM with Missing Expiration Date If there is no expiration date on the yellow DHS-2.FRM, it should be faxed back to the UMC, noting there is no expiration date. 24.45.3.A.3 Current (Not Expired) Yellow DHS-2.FRM If the yellow DHS-2.FRM is not expired: • If the client is currently receiving Medicaid in the Nursing Facility, SSI or Deemed SSI coverage group, the Worker checks the box on the yellow DHS-2.FRM indicating the client is financially eligible and faxes the form back to the UMC. This will initiate medical eligibility to be determined by the UMC. • If not currently financially eligible, the Worker completes the financial eligibility determination following the general application procedures above. A Medicaid