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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 191 Chapter 1 Application/Redetermination Process

Required Action Time Limit Initial review by the MRT staff By the 7th day after receipt Physician review (initial) By the 14th day after receipt Additional medical information requested (if required) by physician By the 7th day after initial physician review Physician’s final review By the 7th day after receipt of additional medical information Final decision (completion of ES-RT-3 and/or DFA-RT-3M form[s]) By the 7th day after final physician’s review File returned to county office By the 3rd day after final physician’s review Notice to the client By the 7th day after receipt of final decision at county office

1.19.5 PAYEE The client is the payee. Couples may decide who the payee is. 1.19.6 REDETERMINATION SSI-Related/Non-Cash Assistance Medicaid AGs are redetermined every twelve months in the last month of the current POC. When possible, the redetermination process is completed automatically using electronic data matches without requiring information from the client. This redetermination process is initiated by the eligibility system, which matches current information with the Federal Data Services HUB and the Asset Verification System (AVS). If determined eligible after completing the redetermination process, the DoHS will notify the client. The notice will identify the information used to determine eligibility. If the customer agrees with the information, no further action is required. If the client does not agree, he is to report the information that does not match the circumstances. These changes will be treated as a change in circumstance during the certification period. When the redetermination process cannot be completed automatically, a pre-populated form is generated by the eligibility system and sent to the client.