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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 2 Chapter 1 Application/Redetermination Process

Program and Form ID Name of Form When to Use Due Date of Additional Information Agency Time Limits MEDICAID AND OTHER HEALTH COVERAGE PROGRAMS Adult Group DFA-2 or

WV PATH Application for All Programs of Assistance Applicant is being considered for all programs. The client and the Worker agree on the date by which additional verification must be obtained. Eligibility system action must be taken to approve, deny or withdraw the application within 30 days of the date of application.

DFA-SLA-1 Application for Healthcare Coverage For a family or when there is more than one individual in the household applying for health care coverage only. DFA-SLA-2 Application for Healthcare Coverage – Short Form For a single individual applying for health care coverage only. AFDC-Related Medicaid DFA-2 or

WV PATH Application for All Programs of Assistance Applicant is being considered for all programs. Additional information is due 30 days from the date of application Eligibility system action to approve, deny or withdraw the application must be taken within 30 days of the date of application.