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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 9 Chapter 1 Application/Redetermination Process

Program and Form ID Name of Form When to Use Due Date of Additional Information Agency Time Limits DFA-QSQ-1

Medicare Assistance Programs Application When Low Income Subsidy (LIS) files are received from the Social Security Administration (SSA), applicants who are not current Medicare Premium Assistance (MPA) recipients are issued a DFA-QSQ-1 through the eligibility system. reasonable time for the client to return the information. • When the client mails the application or completes the application in WV PATH or the Marketplace, the Worker then uses the verification checklist or form DFA-6 in inform the client of additional information needed. The client must be given at least 10 days after the date the verification checklist or DFA-6 is mailed to return the information. For LIS/MPA applicants: • Action must be taken within 30 days of the date the file is received by the eligibility system. • When the eligibility system determines a LIS/MPA applicant is a current MPA recipient, no notice is sent. • The next business day after the eligibility system receives SSA’s LIS data, the system issues a DFA-QSQ-1. If the DFA-QSQ-1 is not returned within 31 days from the date the eligibility system received the LIS file, the eligibility system sends a denial notice. No action is required by the Worker Special Pharmacy DFA-SP-1 Special Pharmacy Application The DFA-SP-1 for Special Pharmacy coverage is completed by the Worker and forwarded to the DFA Medicaid Policy Unit for consideration. This is an interdepartmental form and is not given to or completed by the client. All information must be submitted with the DFA-SP-1. The Worker must submit the DFA-SP-1 to the DFA Medicaid Policy Unit within 10 days of completion. DFA must make a decision and notify the Worker of that decision within 30 days from the date the completed DFA-SP-1 is received.