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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 208 Chapter 1 Application/Redetermination Process

Phase of BCC, assuming all other BCC requirements are met. Follow the eligibility system instructions for coding BCC using PRD-38. While the client is in the Presumptive Phase of BCC, the Worker will determine if the client is eligible for any mandatory Medicaid coverage groups. • The Worker must contact the client and arrange for a Medicaid application to be completed and to request any additional information needed to determine eligibility. • If the Worker determines that the client is NOT eligible for a mandatory Medicaid coverage group, the Worker must disenroll the client from the Presumptive Phase of BCC and enroll them in Regular BCC Medicaid. Follow the eligibility system instructions for coding BCC using PRD-38. Scan documents into the clients case file and make thorough case comments. • If the client is eligible for a mandatory Medicaid coverage group, disenroll the client from the Presumptive Phase of BCC Medicaid and approve the new Medicaid coverage group. Scan appropriate documents to the client’s case and make thorough case comments. • Failure to complete or cooperate in the Medicaid application process will result in closure of the BCC case.

NOTE: At application, if a worker receives the DFA-BCC-1 or the CDC Certificate of Diagnosis directly from the client or medical facility, do not approve the client for BCC Medicaid. In the eligibility system, create a Request for Assistance and scan the documents to the client’s file. Mail the DFA-BCC-1 and the CDC Certificate to WVBCCSP. If the client is determined eligible for WVBCCSP, WVBCCSP will then fax the completed DFA-BCC-1, the CDC Certificate of Diagnosis, and a Letter of Eligibility to the client’s local DOHS office for a Worker to process and determine eligibility for BCC Medicaid.