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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 12 Chapter 1 Application/Redetermination Process

Program and Form ID Name of Form When to Use Due Date of Additional Information Agency Time Limits N/A N/A There is no application procedure for this coverage group, instead the Worker is expected to evaluate all AGs which become ineligible for Parents/Caretaker Relatives Medicaid due to hours of employment, amount of employment income. Not applicable. Not applicable. West Virginia Children’s Health Insurance Program (WVCHIP) DFA-2 or

WV PATH

Application for All Programs of Assistance Applicant is being considered for all programs. Prior to approval for WVCHIP, the client must be determined ineligible for all MAGI Medicaid coverage groups; therefore, the Children Under Age 19 coverage group application procedures apply.

If the Worker decides that additional information is required, the Worker must immediately send a request for the information that includes notification that the application is being held pending receipt of that information and the start date of his WVCHIP coverage may be delayed if he does not respond by the due date.

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.