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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 38 Chapter 1 Application/Redetermination Process

When an application is requested by mail, the DFA-2 or other appropriate program application must be sent. The DFA-RFA-1 must not be mailed to the client. 1.3.4 MEDICAID APPLICATION FORMS 1.3.4.A Single Streamlined Application (SLA), DFA-SLA-1, DFA-SLA-2 1.3.4.A.1 Purpose The SLA, also known as the Application for Health Coverage and Help Paying Cost, allows individuals to apply with the Department for all health coverage programs including WVCHIP. The DFA-SLA-1 and DFA-SLA-2 (short form) are the shelf document (paper) versions of the single-streamlined application used to apply for health coverage only. These applications collect information needed to determine eligibility for health care coverage groups on the basis of Modified Adjusted Gross Income (MAGI). • The DFA-SLA-1 is used for a family, or when there is more than one individual in the household. • The DFA-SLA-2 is used by a single individual. The SLA is available at community and business sites throughout the State. The form is given to anyone who requests it, regardless of the county in which he resides, if different from the county of the special outreach site. The SLA must be available for distribution in all county DOHS offices and provided to anyone who makes the request. When the client requests the SLA mailed to him, this must occur the same day as his request. When received, the client has the option of completing the SLA the day he receives the form and leaving it at the DOHS office for processing, taking it with him for completion and returning it to the local office at a later date, or returning with the form for completion in the office. NOTE: Regardless of the option chosen, at no point is the applicant required to register with the receptionist or meet with a Worker in order to receive a SLA or have it processed.