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West Virginia Income Maintenance Manual Chapter 24

West Virginia Income Maintenance Manual Page 154 Chapter 24 Long Term Care

24.50 APPLICATION 24.50.1 GENERAL APPLICATION PROCEDURES 24.50.1.A APPLICATION FORMS The Application for Benefits (DFA-2), the Application for Long Term Care Medicaid and Children with Disabilities Community Service (DFA-MA-1), or the Application for Healthcare Coverage (DFA-SLA-1) with the Supplement for Healthcare Coverage (DFA-SLA-S1) is acceptable. Applications may also be submitted via WV PATH. When medical eligibility for the Children with Disabilities Community Service Program (CDCSP) is established by the Bureau for Medical Services (BMS) and the Case Management Agency (CMA), a memorandum is sent to the Community Services Manager (CSM). The memorandum is given to the Worker who, with the completed application, determines financial eligibility. The client must verify he has been denied Supplemental Security Income (SSI). The following information is provided solely for the understanding of the process and not the responsibility of the worker: • Additional forms related to medical eligibility and cost of services must also be completed as part of the eligibility determination process. This information is sent directly to the BMS by the CMA. See Section 24.55. • BMS determines the annual cost of institutionalization, the annual cost of in-home care under the CDCSP, and the cost of the type of services necessary for the child to decide the cost-effectiveness of the proposed in-home plan. • CDCSP-2A or 2B: This is the medical form the child's physician uses to submit necessary information to allow a determination of medical eligibility. • CDCSP-6: This is the cost estimate worksheet for medical services that must be completed and used by the CMA to: o Assure the program plan is cost feasible (e.g., community services cost less than placement in a medical institution).