Page 2130

West Virginia Income Maintenance Manual Chapter 26

West Virginia Income Maintenance Manual Page 6 Chapter 26 Medicaid Work Incentive (M-WIN)

DOHS-Medicaid P. O. Box 40288 Charleston, WV 25364 26.2.5.B.2 Payment Premium payments are due the 16th of the coverage month and are considered overdue if not received by the 26th of the coverage month. Local and State offices do not accept Premium payments. The contract agency does not accept advance payments for future anticipated premium payments. They are returned. Anticipated Premium Payment Example: Mr. Rosemary receives his federal income tax refund. He sends the remainder of his premiums for his current period of eligibility and the next twelve month’s premiums to the contract agency. These are returned because the Worker cannot assume Mr. Rosemary’s premiums will remain the same or that he will be eligible for M-WIN beyond his current twelve- month period of eligibility. If the client reapplies after closure due to non-payment of a premium(s), he must pay the enrollment fee again, but is not required to pay the missed premium(s). When M-WIN Medicaid benefits are continued due to a Fair Hearing request, the premium(s) must be paid for any continued month at the last established amount. 26.2.5.B.3 Refund of Payment NOTE: Except in the case of agency error, the enrollment fee must be paid each time the client loses coverage under this program for any reason. This includes, but is not limited to, non-payment of the monthly premium, failure to complete a redetermination of eligibility, or voluntary disenrollment.

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Page 2130

Official source

West Virginia Income Maintenance Manual Chapter 26

West Virginia Income Maintenance Manual Page 6 Chapter 26 Medicaid Work Incentive (M-WIN)

DOHS-Medicaid P. O. Box 40288 Charleston, WV 25364 26.2.5.B.2 Payment Premium payments are due the 16th of the coverage month and are considered overdue if not received by the 26th of the coverage month. Local and State offices do not accept Premium payments. The contract agency does not accept advance payments for future anticipated premium payments. They are returned. Anticipated Premium Payment Example: Mr. Rosemary receives his federal income tax refund. He sends the remainder of his premiums for his current period of eligibility and the next twelve month’s premiums to the contract agency. These are returned because the Worker cannot assume Mr. Rosemary’s premiums will remain the same or that he will be eligible for M-WIN beyond his current twelve- month period of eligibility. If the client reapplies after closure due to non-payment of a premium(s), he must pay the enrollment fee again, but is not required to pay the missed premium(s). When M-WIN Medicaid benefits are continued due to a Fair Hearing request, the premium(s) must be paid for any continued month at the last established amount. 26.2.5.B.3 Refund of Payment NOTE: Except in the case of agency error, the enrollment fee must be paid each time the client loses coverage under this program for any reason. This includes, but is not limited to, non-payment of the monthly premium, failure to complete a redetermination of eligibility, or voluntary disenrollment.