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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 176 Chapter 1 Application/Redetermination Process

1.16.10.B Redetermination Schedule QMB, SLIMB and QI-1 cases are redetermined annually, scheduled in the 12th month of eligibility. 1.16.10.C Redetermination Date 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 the 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 circumstances during the certification period. When the redetermination process cannot be completed automatically, a pre-populated form and letter of explanation is generated by the eligibility system and sent 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 letter of explanation provides the following information: • A statement that the AG(s) for the individual(s) listed is due for redetermination; • The address to which the form is returned, if submitted by mail; • The date by which the redetermination must be submitted; • Any verification which must be submitted with the form; Note: An individual deemed eligible for Qualified Medicare Beneficiary (QMB) due to receiving SSI will not have a redetermination cycle for the coverage. The QMB coverage is continued as long as the client is considered eligible for SSI according to SSA and entitled to premium-free Medicare Part A and/or enrolled in Medicare Part B. The eligibility system will provide an alert when the client is no longer SSI eligible. The eligibility system will set a redetermination date for two months after SSI Medicaid closure and mail the redetermination form.