Page 361

West Virginia Income Maintenance Manual Chapter 3

West Virginia Income Maintenance Manual Page 50 Chapter 3 Eligibility Determination Groups

3.7 ADULT GROUP The Patient Protection and Affordable Care Act, amended by the Health Care and Education Reconciliation Act of 2010, enacted March 30, 2010, are together referred to as the Affordable Care Act (ACA). The ACA established the categorically mandatory coverage group known as the Adult Group. Effective January 1, 2014, Medicaid coverage is provided to individuals age 19 or older and under age 65 who are not otherwise eligible for and enrolled in another categorically mandatory Medicaid coverage group, and are not entitled to or enrolled in Medicare Part A or B. Eligibility for this group is determined using Modified Adjusted Gross Income (MAGI) methodologies established in Section 4.7. 3.7.1 THE ASSISTANCE GROUP (AG) 3.7.1.A Who Must Be Included? Adults age 19 or older and under age 65. 3.7.1.B Who Cannot Be Included? • Individuals eligible for these categorically mandatory coverage groups: o Supplemental Security Income (SSI) o Deemed SSI o Parents/Caretakers o Pregnant Women o Children Under Age 19 o Former West Virginia Foster Children • Individuals entitled to or enrolled in Medicare Part A or B • Parents or other caretaker relatives living with a dependent child under the age of 19, unless the child is also receiving benefits under Medicaid, WVCHIP, or other minimum essential coverage (MEC). See definition in Section 4.2. If a woman indicates at application or review that she is pregnant, she is not eligible to be included in the Adult Group; she must be evaluated for the Pregnant Women coverage group.

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Page 361

Official source

West Virginia Income Maintenance Manual Chapter 3

West Virginia Income Maintenance Manual Page 50 Chapter 3 Eligibility Determination Groups

3.7 ADULT GROUP The Patient Protection and Affordable Care Act, amended by the Health Care and Education Reconciliation Act of 2010, enacted March 30, 2010, are together referred to as the Affordable Care Act (ACA). The ACA established the categorically mandatory coverage group known as the Adult Group. Effective January 1, 2014, Medicaid coverage is provided to individuals age 19 or older and under age 65 who are not otherwise eligible for and enrolled in another categorically mandatory Medicaid coverage group, and are not entitled to or enrolled in Medicare Part A or B. Eligibility for this group is determined using Modified Adjusted Gross Income (MAGI) methodologies established in Section 4.7. 3.7.1 THE ASSISTANCE GROUP (AG) 3.7.1.A Who Must Be Included? Adults age 19 or older and under age 65. 3.7.1.B Who Cannot Be Included? • Individuals eligible for these categorically mandatory coverage groups: o Supplemental Security Income (SSI) o Deemed SSI o Parents/Caretakers o Pregnant Women o Children Under Age 19 o Former West Virginia Foster Children • Individuals entitled to or enrolled in Medicare Part A or B • Parents or other caretaker relatives living with a dependent child under the age of 19, unless the child is also receiving benefits under Medicaid, WVCHIP, or other minimum essential coverage (MEC). See definition in Section 4.2. If a woman indicates at application or review that she is pregnant, she is not eligible to be included in the Adult Group; she must be evaluated for the Pregnant Women coverage group.