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West Virginia Income Maintenance Manual Chapter 26

West Virginia Income Maintenance Manual Page 29 Chapter 26 Medicaid Work Incentive (M-WIN)

26.11 CASE MAINTENANCE 26.11.1 CLOSURES A Medicaid Work Incentive (M-WIN) client may be determined ineligible prior to the end of the twelve-month eligibility period if he: • Moves out of state • Dies • Reaches age 65 • Becomes eligible for Supplemental Security Income (SSI) • Was approved for M-WIN in error and is not currently eligible • Is determined no longer disabled by the Social Security Administration (SSA) or the Medical Review Team (MRT) • Acquires assets over the allowable limit • Terminates employment voluntarily or employment is no longer competitive; see Section 26.11.4. • Fails to meet the requirements in Section 26.11.4 when determined unable to maintain employment – involuntary • Fails to pay a required enrollment fee or premium payment(s) • Voluntarily disenrolls When the assistance group (AG) is closed for any reason, including voluntary disenrollment, advance notice is required. See Section 9.3.1.B for when advance notice requirements are waived. Any notice must inform the client of the last month for which a premium is due. The contract agency is notified of the termination and the effective date of closure, i.e., the last day of the last month for which the premium is due. NOTE: 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 the redetermination of eligibility or voluntary disenrollment.

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Page 2153

Official source

West Virginia Income Maintenance Manual Chapter 26

West Virginia Income Maintenance Manual Page 29 Chapter 26 Medicaid Work Incentive (M-WIN)

26.11 CASE MAINTENANCE 26.11.1 CLOSURES A Medicaid Work Incentive (M-WIN) client may be determined ineligible prior to the end of the twelve-month eligibility period if he: • Moves out of state • Dies • Reaches age 65 • Becomes eligible for Supplemental Security Income (SSI) • Was approved for M-WIN in error and is not currently eligible • Is determined no longer disabled by the Social Security Administration (SSA) or the Medical Review Team (MRT) • Acquires assets over the allowable limit • Terminates employment voluntarily or employment is no longer competitive; see Section 26.11.4. • Fails to meet the requirements in Section 26.11.4 when determined unable to maintain employment – involuntary • Fails to pay a required enrollment fee or premium payment(s) • Voluntarily disenrolls When the assistance group (AG) is closed for any reason, including voluntary disenrollment, advance notice is required. See Section 9.3.1.B for when advance notice requirements are waived. Any notice must inform the client of the last month for which a premium is due. The contract agency is notified of the termination and the effective date of closure, i.e., the last day of the last month for which the premium is due. NOTE: 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 the redetermination of eligibility or voluntary disenrollment.