Page 969

West Virginia Income Maintenance Manual Chapter 9

West Virginia Income Maintenance Manual Page 25 Chapter 9 Client Notification

9.4.4 IM-SSIR-1, SSI-RELATED MEDICAID COMPUTATIONS AND DEEMING FORMS: IMM-SSIR-1A, IM-SSIR-1B, IM-SSIR-1C This form must be sent with each DFA-NL-A sent for approval of SSI-related Medicaid benefits. In addition, it must be sent with each DFA-NL-C and DFA-NL-B sent for changes in the spenddown amount. There are three forms used to calculate the amount of income deemed to an SSI-related Medicaid client, as follows: • IM-SSIR-1A Deeming to Spouse • IM-SSIR-1B Deeming to Child • IM-SSIR-1C Deeming to Spouse and Child 9.4.5 WV WORKS REPAYMENT COMPUTATIONS Computation of the WV WORKS overpayment amount must be provided to the client upon request. The form must be mailed to the client or the client's representative within five working days of the receipt of the request. If time permits, the form may be prepared and given to the client during an office interview. 9.4.6 IM-NL-QMB-1, QUALIFIED MEDICARE BENEFICIARIES (QMB) SPECIFIED LOW- INCOME MEDICARE BENEFICIARIES (SLIMB) AND QUALIFIED INDIVIDUALS (QI-1) This form must be sent with each notification of approval, denial, or ineligibility based on income for QMB, SLIMB, or QI-1 applicants or clients. 9.4.7 IM-NL-AC-1, ASSET COMPUTATIONS Asset computations must be provided to the client upon request. The form must be mailed to the client or the client's representative within five working days of receipt of the request. If time permits, the form may be prepared and given to the client during an office interview.

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Page 969

Official source

West Virginia Income Maintenance Manual Chapter 9

West Virginia Income Maintenance Manual Page 25 Chapter 9 Client Notification

9.4.4 IM-SSIR-1, SSI-RELATED MEDICAID COMPUTATIONS AND DEEMING FORMS: IMM-SSIR-1A, IM-SSIR-1B, IM-SSIR-1C This form must be sent with each DFA-NL-A sent for approval of SSI-related Medicaid benefits. In addition, it must be sent with each DFA-NL-C and DFA-NL-B sent for changes in the spenddown amount. There are three forms used to calculate the amount of income deemed to an SSI-related Medicaid client, as follows: • IM-SSIR-1A Deeming to Spouse • IM-SSIR-1B Deeming to Child • IM-SSIR-1C Deeming to Spouse and Child 9.4.5 WV WORKS REPAYMENT COMPUTATIONS Computation of the WV WORKS overpayment amount must be provided to the client upon request. The form must be mailed to the client or the client's representative within five working days of the receipt of the request. If time permits, the form may be prepared and given to the client during an office interview. 9.4.6 IM-NL-QMB-1, QUALIFIED MEDICARE BENEFICIARIES (QMB) SPECIFIED LOW- INCOME MEDICARE BENEFICIARIES (SLIMB) AND QUALIFIED INDIVIDUALS (QI-1) This form must be sent with each notification of approval, denial, or ineligibility based on income for QMB, SLIMB, or QI-1 applicants or clients. 9.4.7 IM-NL-AC-1, ASSET COMPUTATIONS Asset computations must be provided to the client upon request. The form must be mailed to the client or the client's representative within five working days of receipt of the request. If time permits, the form may be prepared and given to the client during an office interview.