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West Virginia Income Maintenance Manual Chapter 26

West Virginia Income Maintenance Manual Page 7 Chapter 26 Medicaid Work Incentive (M-WIN)

Once a monthly premium payment is paid and the M-WIN benefit is received, premium payments are not refunded by the contract agency. The M-WIN coverage group operates similarly to a health insurance plan with premiums not refunded when the benefit was received. 26.2.5.B.4 Non-Payment of Premium/Insufficient Funds When the premium payment is not received by the contract agency by the 26th of the coverage month, the contract agency staff notifies the Department by the 10th of the following month. The eligibility system will be updated and the AG will automatically close on adverse action date and the client is sent advance notice of M-WIN closure for premium non-payment. The contract agency also notifies the Department when premium payments are returned for insufficient funds. This is considered as non-payment. The AG is closed using the same procedures as for non-payment after advance notice. The contract agency is notified of any subsequent AG closures. Overdue Premium Example: Mr. Chive received M-WIN in March. He is mailed his premium due letter April 2 for the month of April. Payment is due April 16 and overdue April 26. If not received, the contract agency notifies the Department by May 10. The client is sent advance notice that his last month of M-WIN is May. A new enrollment fee is necessary to reestablish coverage for June.

EXCEPTION: The contract agency can only reimburse the client for a monthly premium payment when payment occurs due to an agency error. The BMS Policy Unit must request and approve the refund.