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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 24 Chapter 1 Application/Redetermination Process

When the individual’s income is at or below the income limits for Medicaid, the Marketplace will determine the applicant’s eligibility for Medicaid or WVCHIP and forward the data file to the eligibility system. The eligibility system will determine the specific Medicaid or WVCHIP coverage group through which Medicaid will be issued without delay. The Marketplace’s responsibility of determining eligibility for Medicaid is limited to Medicaid coverage implemented through the Affordable Care Act (ACA) in West Virginia effective October 1, 2013 and includes MAGI groups only. The Marketplace is not responsible to assess or determine eligibility for other Medicaid or other Department programs, benefits, or services. When the Worker identifies the individual’s potential eligibility, the Worker notifies the individual of the application process for any other programs or services. 1.2.7 CLIENT NOTIFICATION The client must be notified in writing of the final decision on his application and the reason for it. Notification must be provided for each Program for which the client applied, but notification for more than one program may be included on one form letter. Under some circumstances, the eligibility system automatically generates notification to the client. During the intake interview or during some other client contact prior to written client notification, the Worker may know whether or not the client is eligible and, if so, the amount of the benefit. The Worker may tell the client the status of his application and/or benefit level, if he so chooses. However, even if the client has been told his status and/or benefit level, he must still receive the information in writing. When an applicant may be eligible for a program or Medicaid coverage group for which he did not request, a notification is issued from the eligibility system to inform the applicant that he must contact his local office for information or to apply. 1.2.8 COMPLETION OF THE APPLICATION PROCESS The application process is completed when the following have occurred: NOTE: There is specific, court-ordered client notification policy that must be followed. There are also specific forms that must be used and detailed procedures to follow. See Chapter 9.