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West Virginia Income Maintenance Manual Chapter 4

West Virginia Income Maintenance Manual Page 200 Chapter 4 Income

the verified income amount differs from the client’s statement. The Worker must also explain the spenddown process to the client. A DFA-6A is attached to the verification checklist (DFA-6) that notifies the client that an eligibility decision cannot be made until he meets his spenddown by providing proof of medical expenses. The DFA-6 must also contain any other information the client must supply in order to determine eligibility. The following procedures are required for the spenddown process. • The Worker prepares the DFA-6, attaches a DFA-6A and gives them to the client or mails them. The DFA-6A notifies the client that an eligibility decision cannot be made until he meets his spenddown by providing proof of medical expenses. The DFA-6 must also contain any other information the client must supply in order to determine eligibility. If the client indicates he needs help to understand the procedure for meeting his spenddown, the Worker provides all help needed. In no instance is the client to be denied Medicaid because he is physically, mentally, or emotionally unable to verify his medical expenses. • The client is requested to provide proof of his medical expenses, date incurred, type of expense and amount, and to submit them to the Worker by the application processing deadline. • Medical bills are entered and tracked in the eligibility system as they are received. When the bills or verification are received, the Worker reviews the information to determine: o The expenses were incurred, they are not payable by a third party, and the client will not be reimbursed by a third party. o The individual(s) who received the medical service is one of the persons described in Section 4.14.4.J.2 below. o The expenses are for medical services and are appropriate to use to meet a spenddown. See Section 4.14.4.J.3 below. • The Worker must enter the pertinent information about expenses received from the client in the eligibility system. This information includes: o The date of service o The provider of the service o The total amount of the bill o The third-party liability amount