Page 2201

West Virginia Income Maintenance Manual Chapter 29

West Virginia Income Maintenance Manual Page 2 Chapter 29 COVID-19 Testing Group Medicaid

29.2 APPLICATION PROCESS 29.2.1 APPLICATION FORM The application for COVID-19 Testing Group Medicaid is completed by the applicant, or authorized representative, preferably at the time of testing. The application is submitted by the Medicaid provider along with the claims submission. The form must include: • Applicant’s name; • Applicant’s address; • Applicant’s date of birth; • Applicant’s social security number; and, • Applicant’s signature, or signature of authorized representative. 29.2.2 COMPLETED APPLICATION The application is considered complete when all relevant sections have been completed on the form and is signed by the applicant or authorized representative. 29.2.3 DATE OF APPLICATION The date of application is the date the applicant submits a completed application to the department. 29.2.4 DATES OF ELIGIBILITY The beginning date of eligibility is the first day of the month of application, if eligible. Eligibility may be backdated up to three months prior to the month of application, provided all eligibility requirements were met. Eligibility will end the last day of the 12th month of eligibility, or the last day of the month of the end of the COVID-19 Public Health Emergency, whichever comes first. Advance notice