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West Virginia Income Maintenance Manual Chapter 26
West Virginia Income Maintenance Manual Page 5 Chapter 26 Medicaid Work Incentive (M-WIN)
Medicaid rather than M-WIN. Because she has no other medical bills remaining, she requests the contract agency retain her enrollment fee to apply against a future M-WIN period of eligibility. Ms. Pine does not know if she will incur additional medical bills in the next six months or if she will be working. The contract agency refunds her enrollment fee. Anticipated Enrollment Payment Example 2: Same situation as above, except Ms. Pine contacts her Worker after the AG is confirmed and the M-WIN benefit issued. Because the Worker explained the advantages of both M-WIN and SSI- Related Medicaid, documented Ms. Pine’s choice of M-WIN, and she received the M-WIN benefit, no refund is given. Agency Error Example: Same situation as in the example above. The Worker failed to explain that Ms. Pine was potentially eligible for both M-WIN and SSI- Related Medicaid. Ms. Pine learns she would not have a monthly premium if she had chosen SSI-Related Medicaid. She had old medical bills that had never been used to meet a spenddown. Because the Worker failed to follow the policy requirement regarding explanation of eligible coverage groups, the enrollment fee was paid as a result of DOHS error. The Bureau for Medical Services (BMS) Policy Unit contacts the contract agency and requests reimbursement. 26.2.5.B Monthly Premium Payments When the enrollment fee is paid, the first month’s premium is waived. The following and subsequent months require a premium payment for enrollment to continue. 26.2.5.B.1 Notification The contract agency sends premium due letters and payment stubs to M-WIN clients on approximately the second day of the month in which the premium is due. To ensure proper credit of payment, the client must mail the stub and payment in the window envelope provided addressed to: EXCEPTION: The contract agency can reimburse the client only when he pays the enrollment fee solely due to an agency error. The BMS Policy Unit must request and approve the refund.