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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 27 Chapter 1 Application/Redetermination Process

1.2.11 REDETERMINATIONS Each program and Medicaid coverage group has its own policies related to redetermination. Please see the program-specific sections for details. NOTE: At redetermination for one program or Medicaid coverage group, the client may want to apply for an additional benefit. If so, the same DFA-2 or WV PATH application is used as an application for the new benefit and a redetermination for the active AG, regardless of the program or Medicaid coverage group. MEDICAID-ONLY NOTE: AFDC-Related and SSI-Related Medicaid AGs that do not have a spenddown, but are closed due to a change in the AG’s circumstances that results in a spenddown, are not required to reapply or complete a new application for the new period of consideration (POC) that follows AG closure. See Section 10.17. MEDICAID-ONLY NOTE: When the latest application form is a DFA-SLA-1 or a DFA- QSQ- 1, the AG may only be reopened for a Medicaid coverage group for which such forms are appropriate. Medicaid and WVCHIP NOTE: If coverage is closed for failure to submit a redetermination form, or necessary information, but the client responds and provides the information within 90 days of the effective date of closure, the Worker must determine eligibility in a timely manner without requiring a new application. Eligibility may be back dated up to three months, provided all eligibility requirements were met.

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Page 60

Official source

West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 27 Chapter 1 Application/Redetermination Process

1.2.11 REDETERMINATIONS Each program and Medicaid coverage group has its own policies related to redetermination. Please see the program-specific sections for details. NOTE: At redetermination for one program or Medicaid coverage group, the client may want to apply for an additional benefit. If so, the same DFA-2 or WV PATH application is used as an application for the new benefit and a redetermination for the active AG, regardless of the program or Medicaid coverage group. MEDICAID-ONLY NOTE: AFDC-Related and SSI-Related Medicaid AGs that do not have a spenddown, but are closed due to a change in the AG’s circumstances that results in a spenddown, are not required to reapply or complete a new application for the new period of consideration (POC) that follows AG closure. See Section 10.17. MEDICAID-ONLY NOTE: When the latest application form is a DFA-SLA-1 or a DFA- QSQ- 1, the AG may only be reopened for a Medicaid coverage group for which such forms are appropriate. Medicaid and WVCHIP NOTE: If coverage is closed for failure to submit a redetermination form, or necessary information, but the client responds and provides the information within 90 days of the effective date of closure, the Worker must determine eligibility in a timely manner without requiring a new application. Eligibility may be back dated up to three months, provided all eligibility requirements were met.