1.1 INTRODUCTION GENERAL INFORMATION... 2 A. APPLICANT AND POTENTIAL APPLICANT S RIGHTS... 2

Transcription

1 1.1 INTRODUCTION GENERAL INFORMATION... 2 A. APPLICANT AND POTENTIAL APPLICANT S RIGHTS Right To Apply Right To General Information... 2a 3. Right To Consideration For All Programs... 2a 4. Right To Voter Registration Services Right to Fair and Equitable Treatment of Applicants and Recipients... 3 B. OVERVIEW OF THE ELIGIBILITY DETERMINATION PROCESS... 4e 1. Application Process... 4e 2. Redetermination Process... 4e 3. Case Reviews and Case Maintenance... 4f 4. Resource Development... 4f C. APPLICATION REGISTER AND OTHER COUNTY CONTROLS... 4f 1. Application Register... 4f 2. Home Visit Register... 4g D. WORKER RESPONSIBILITIES... 4g E. CLIENT RESPONSIBILITY... 6a F. APPLICANT RECEIVES BENEFITS FROM ANOTHER STATE... 6b G. CONTINUATION OF THE CASE NUMBER AND TRANSFER OF A CLOSED CASE... 7 H. WHEN APPLICATION IS MADE OR RECEIVED IN THE INCORRECT COUNTY OFFICE Applications Made In Person Or By Mail Applications Submitted By Use Of inroads Applications Made In Person Or By Mail Initiated From The SSA s Low Income Subsidy (LIS)/Medicare Premium Assistance (MPA) Data Exchange / i

2 I. GENERAL REQUIREMENTS FOR THE INTAKE INTERVIEW... 9 J. HOME VISITS K. MAIL-IN, inroads AND APPLICATIONS INITIATED FROM THE SSA s LIS/MPA DATA EXCHANGE AND REDETERMINATIONS... 10a 1. Applications Submitted By Mail... 10a 2. Applications Submitted By inroads Applications Submitted By inroads From A Community Partner Applications Submitted From the SSA s Low Income Subsidy (LIS)/Medicare Premium Assistance (MPA) Data Exchange Applications for Insurance Affordability Programs Coordinated with the Marketplace Redeterminations Submitted by Mail Redetermination Submitted by inroads Hospital-Based Presumptive Eligibility Applications Submitted Through inroads From the West Virginia Division of Corrections (DOC) or Regional Jail Authority (RJA) L. CLIENT NOTIFICATION, WRITTEN AND VERBAL M. COMPLETION OF THE APPLICATION PROCESS N. COMMUNICATION WITH SOCIAL SECURITY ADMINISTRATION (SSA) O. DOMESTIC VIOLENCE ASSISTANCE P. DETERMINING RACE AND ETHNICITY FOR FEDERAL REPORTING Race... 18a 2. Ethnicity... 18a 1.3 APPLICATION FORMS A. DFA-2 and inroads DFA-2 Generated by erapids DFA-2 Shelf Document / ii

3 B. DFA-RR C. DFA-SNAP D. DFA-QSQ E. DFA-RFA F. DFA-SLA-1 and DFA-SLA G. DFA-SLA-S H. REAPPLICATIONS NOT REQUIRING A NEW FORM Medicaid and WV WORKS SNAP Benefits... 22a I. ADDITION OF ANOTHER BENEFIT TO AN ACTIVE CASE WHEN NEW APPLICATION FORM IS NOT REQUIRED SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) APPLICATION PROCESS A. APPLICATION FORMS B. COMPLETE APPLICATION C. DATE OF APPLICATION... 26a D. INTERVIEW REQUIRED E. WHO MUST BE INTERVIEWED F. WHO MUST SIGN G. CONTENT OF THE INTERVIEW H. DUE DATE OF ADDITIONAL INFORMATION I. AGENCY TIME LIMITS / iii

4 J. AGENCY DELAYS K. PAYEE L. REPAYMENT AND PENALTIES Repayment Penalties M. BEGINNING DATE OF ELIGIBILITY... 32a N. REDETERMINATION SCHEDULE... 32a O. EXPEDITED PROCESSING Eligibility Requirements Screening For Expedited Service Variations In Usual Procedures P. CLIENT NOTIFICATION Q. DATA SYSTEM ACTION R. SPECIAL CONSIDERATIONS Joint SSI/FS Mail-In Food Stamp Applications Categorical Eligibility Procedures For Missed Scheduled Interviews S. APPLICATION/REDETERMINATION VARIATIONS Redetermination Cycle Scheduling Interviews Completion Overdue Redetermination... 48b 5. SNAP Waiver of the Face-to-Face Interview... 48b T. THE BENEFIT... 48e 1. Initial Benefits Ongoing Benefits Electronic Benefits Transfer (EBT) / iv

5 U. PERSONAL RESPONSIBILITY CONTRACT (PRC) V. ORIENTATION ADULT GROUP... 54a A. APPLICATION FORMS... 54a B. COMPLETE APPLICATION... 54a C. DATE OF APPLICATION... 54a D. INTERVIEW REQUIRED... 54a E. WHO CAN BE INCLUDED ON THE SAME APPLICATION... 54a F. WHO MUST SIGN... 54b G. CONTENT OF THE INTERVIEW... 54b H. DUE DATE OF ADDITIONAL INFORMATION... 54c I. AGENCY TIME LIMITS... 54c J. AGENCY DELAYS... 54c K PAYEE... 54c L. REPAYMENT AND PENALTIES... 54c M. BEGINNING DATE OF ELIGIBILITY... 54c M. REDETERMINATION SCHEDULE... 54d O. EXPEDITED PROCESSING... 54d P. CLIENT NOTIFICATION... 54d Q. DATA SYSTEM ACTION... 54d R. REDETERMINATION SCHEDULE AND SPECIAL PROCEDURES... 54d 1. Redetermination Schedule... 54d 2. Special Procedures Redeterminations... 54e 6/ v

6 S. THE BENEFIT... 54f 1. Retroactive Benefits... 54f 2. Ongoing Benefits... 54f 3. Ending Date of Eligibility T. PERSONAL RESPONSIBILITY CONTRACT (PRC) U. ORIENTATION PARENTS/CARETAKER RELATIVES A. APPLICATION FORMS B. COMPLETE APPLICATION C. DATE OF APPLICATION D. INTERVIEW REQUIRED E. WHO CAN BE INCLUDED ON THE SAME APPLICATION F. CONTENT OF THE INTERVIEW G. DUE DATE OF ADDITIONAL INFORMATION H. AGENCY TIME LIMITS I. AGENCY DELAYS J. PAYEE K REPAYMENT AND PENALTIES L. BEGINNING DATE OF ELIGIBILITY... 58a M. REDETERMINATION SCHEDULE... 58a N. EXPEDITED PROCESSING... 58a O. CLIENT NOTIFICATION P. DATA SYSTEM ACTION Q. REDETERMINATION SCHEDULE AND SPECIAL PROCEDURES Redetermination Schedule Special Procedures Rolling Renewals / vi

7 R. THE BENEFIT... 60b 1. Retroactive Benefits... 60b 2. Ongoing Benefits... 60b 3. Ending Date Of Eligibility... 60b S. PERSONAL RESPONSIBILITY CONTRACT (PRC)... 60b T. ORIENTATION... 60b 1.7 MEDICAID FOR DEEMED PARENTS/CARETAKER RELATIVES RECIPIENTS A. EXTENDED MEDICAID B. CHILDREN COVERED AS RECIPIENTS OF ADOPTION ASSISTANCE C. CHILDREN COVERED AS RECIPIENTS OF FOSTER CARE PAYMENTS TRANSITIONAL MEDICAID (TM) CHILDREN UNDER AGE A. APPLICATION FORMS Choosing The Correct Form Special Outreach/Application Procedures B. COMPLETE APPLICATION C. DATE OF APPLICATION D. INTERVIEW REQUIRED E. WHO CAN BE INCLUDED ON THE SAME APPLICATION... 64a F. WHO MUST SIGN Application Form or INROADS Signature Page Electronic Signature G. CONTENT OF THE INTERVIEW H. DUE DATE OF ADDITIONAL INFORMATION I. AGENCY TIME LIMITS J. AGENCY DELAYS / via

8 K. PAYEE L. REPAYMENT AND PENALTIES M. BEGINNING DATE OF ELIGIBILITY N. REDETERMINATION SCHEDULE O. EXPEDITED PROCESSING... 66a P. CLIENT NOTIFICATION... 66a Q. DATA SYSTEM ACTION... 66a R. REDETERMINATION SCHEDULE AND SPECIAL PROCEDURES... 66a 1. Redetermination Schedule... 66a 2. Special Procedures Rolling Renewals S. THE BENEFIT PREGNANT WOMEN A. APPLICATION FORMS B. COMPLETE APPLICATION C. DATE OF APPLICATION D. WHO CAN BE INCLUDED ON THE SAME APPLICATION E. EXPEDITED PROCESSING... 70a F. DUE DATE OF ADDITIONAL INFORMATION... 70a G. AGENCY DELAYS H. BEGINNING DATE OF ELIGIBILITY Application While Pregnant Application After Pregnancy Ends I. SPECIAL PROCEDURE / vii

9 J. CLIENT NOTIFICATION K. REDETERMINATION SCHEDULE L. REDETERMINATION SCHEDULE AND SPECIAL PROCEDURES Redetermination Schedule and Special Procedures Specific Procedures Rolling Renewals... 72b M. THE BENEFIT... 72b 1.11 RESERVED FOR FUTURE USE... 72a 1.12 CONTINUOUSLY ELIGIBLE NEWBORN CHILDREN A. APPLICATION FORM B. THE REDETERMINATION PROCESS C. THE BENEFIT Initial Benefit Ongoing Benefit Ending Date Of Eligibility SSI RECIPIENTS A. APPROVALS FROM DATA EXCHANGE B. APPROVALS AT THE REQUEST OF THE BMS MEDICARE BUY-IN UNIT C. APPROVALS FROM THE SOCIAL SECURITY STATE ONLINE QUERY (SOLQ) D. OTHER APPROVALS E. ESTABLISHING THE DATE OF APPLICATION F. WHO MUST BE INTERVIEWED G. WHO MUST SIGN H. DUE DATE OF ADDITIONAL INFORMATION I. AGENCY TIME LIMITS / viii

10 J. AGENCY DELAYS K. PAYEE L. REPAYMENT AND PENALTIES M. BEGINNING DATE OF ELIGIBILITY N. REDETERMINATION SCHEDULE O. EXPEDITED PROCESSING P. CLIENT NOTIFICATION Q. DATA SYSTEM ACTION R. REDETERMINATION VARIATIONS S. THE BENEFIT Retroactive Benefits Ongoing Benefits Ending Date Of Eligibility DEEMED SSI RECIPIENTS QUALIFIED MEDICARE BENEFICIARIES (QMB), SPECIFIED LOW-INCOME MEDICARE BENEFICIARIES (SLIMB) AND QUALIFIED INDIVIDUALS (QI-1) A. APPLICATION FORMS Applications Requested By Mail or inroads Applications Initiated From SSA s LIS/MPA Data Exchange B. COMPLETE APPLICATION... 82a C. DATE OF APPLICATION... 82a D. WHO MUST BE INTERVIEWED E. WHO MUST SIGN F. CONTENT OF THE INTERVIEW G. DUE DATE OF ADDITIONAL INFORMATION H. AGENCY TIME LIMITS / ix

11 I. AGENCY DELAYS... 84a J. PAYEE... 84a K. REPAYMENT AND PENALTIES... 84a L. BEGINNING DATE OF ELIGIBILITY... 84a 1. QMB... 84a 2. SLIMB... 84b 3. QI b M. REDETERMINATION SCHEDULE... 84b N. EXPEDITED PROCESSING... 84c O. CLIENT NOTIFICATION... 84c P. REDETERMINATION VARIATIONS... 84c 1. The Redetermination List... 84c 2. The Date Of The Redetermination... 84c 3. Scheduling The Redetermination... 84d 4. Completion Of The Redetermination... 84d Q. THE BENEFIT... 84d 1. QMB... 84d 2. SLIMB And QI Ending Date of Eligibility QUALIFIED DISABLED WORKING INDIVIDUALS (QDWI) A. APPLICATION FORMS B. COMPLETE APPLICATION C. DATE OF APPLICATION D. INTERVIEW REQUIRED E. WHO MUST BE INTERVIEWED F. WHO MUST SIGN G. CONTENT OF THE INTERVIEW / x

12 H. DUE DATE OF ADDITIONAL INFORMATION I. AGENCY TIME LIMITS J. AGENCY DELAYS K. PAYEE L. REPAYMENT AND PENALTIES M. BEGINNING DATE OF ELIGIBILITY N. REDETERMINATION SCHEDULE O. EXPEDITED PROCESSING P. CLIENT NOTIFICATION Q. DATA SYSTEM ACTION R. REDETERMINATION VARIATIONS S. THE BENEFIT ILLEGAL ALIENS A. APPLICATION FORMS B. COMPLETE APPLICATION C. DATE OF APPLICATION D. WHO MUST BE INTERVIEWED E. WHO MUST SIGN F. CONTENT OF THE INTERVIEW G. DUE DATE OF ADDITIONAL INFORMATION H. AGENCY TIME LIMITS I. AGENCY DELAYS J. PAYEE / xi

13 K. REPAYMENT AND PENALTIES L. BEGINNING DATE OF ELIGIBILITY M. REDETERMINATION SCHEDULE N. EXPEDITED PROCESSING O. CLIENT NOTIFICATION P. DATA SYSTEM ACTION Q. REDETERMINATION VARIATIONS R. THE BENEFIT S. ENDING DATE OF ELIGIBILITY INDIVIDUALS RECEIVING HOME AND COMMUNITY BASED SERVICES UNDER TITLE XIX WAIVERS CHILDREN WITH DISABILITIES COMMUNITY SERVICES PROGRAM (CDCS) A. APPLICATION FORMS B. COMPLETE APPLICATION C. DATE OF APPLICATION D. INTERVIEW REQUIRED E. WHO MUST BE INTERVIEWED F. WHO MUST SIGN G. CONTENT OF THE INTERVIEW H. DUE DATE OF ADDITIONAL INFORMATION... 94a I. AGENCY TIME LIMITS... 94a J. AGENCY DELAYS... 94a K. PAYEE / xii

14 L. REPAYMENT AND PENALTIES M. BEGINNING DATE OF ELIGIBILITY N. REDETERMINATION SCHEDULE O. EXPEDITED PROCESSING P. CLIENT NOTIFICATION Q. DATA SYSTEM ACTION R. REDETERMINATION VARIATIONS The Redetermination List The Date Of The Redetermination Scheduling The Redetermination Completion Of The Redetermination S. THE BENEFIT Retroactive Benefits Ongoing Eligibility Ending Date Of Eligibility AIDS DRUG ASSISTANCE PROGRAM (ADAP) A. APPLICATION FORMS DFA-2 or Single-Streamlined Application (SLA) ADAP Application B. COMPLETE APPLICATION C. DATE OF APPLICATION D. INTERVIEW REQUIRED E. WHO MUST BE INTERVIEWED F. WHO MUST SIGN G. CONTENT OF THE INTERVIEW H. DUE DATE OF ADDITIONAL INFORMATION / xiii

15 I. AGENCY TIME LIMITS... 98a J. AGENCY DELAYS... 98a K. PAYEE... 98a L. REPAYMENT AND PENALTIES... 98a M. BEGINNING DATE OF ELIGIBILITY... 98a N. REDETERMINATION SCHEDULE... 98a O. EXPEDITED PROCESSING P. CLIENT NOTIFICATION Q. DATA SYSTEM ACTION R. REDETERMINATION VARIATIONS S. THE BENEFIT AFDC-RELATED MEDICAID A. APPLICATION FORMS B. COMPLETE APPLICATION C. DATE OF APPLICATION D. INTERVIEW REQUIRED E. WHO MUST BE INTERVIEWED a F. WHO MUST SIGN a G. CONTENT OF THE INTERVIEW H. DUE DATE OF ADDITIONAL INFORMATION I. AGENCY TIME LIMITS J. AGENCY DELAYS K. PAYEE / xiv

16 L. REPAYMENT AND PENALTIES M. BEGINNING DATE OF ELIGIBILITY Non-Spenddown Spenddown N. REDETERMINATION SCHEDULE Non-Spenddown Spenddown O. EXPEDITED PROCESSING P. CLIENT NOTIFICATION Q. DATA SYSTEM ACTION R. REDETERMINATION VARIATIONS Non-Spenddown Spenddown AG s S. THE BENEFIT Non-Spenddown Spenddown AG s SSI-RELATED MEDICAID, AGED, BLIND AND DISABLED A. APPLICATION FORMS B. COMPLETE APPLICATION C. DATE OF APPLICATION D. INTERVIEW REQUIRED E. WHO MUST BE INTERVIEWED F. WHO MUST SIGN G. CONTENT OF THE INTERVIEW a H. DUE DATE OF ADDITIONAL INFORMATION a 6/ xv

17 I. AGENCY TIME LIMITS Application Processing Limits MRT Time Limits J. AGENCY DELAYS K. PAYEE L. REPAYMENT AND PENALTIES M. BEGINNING DATE OF ELIGIBILITY Non-Spenddown Spenddown N. REDETERMINATION SCHEDULE Non-Spenddown Spenddown O. EXPEDITED PROCESSING P. CLIENT NOTIFICATION Q. DATA SYSTEM ACTION R. REDETERMINATION VARIATIONS Non-Spenddown Spenddown S. THE BENEFIT Non-Spenddown Spenddown SSI-RELATED/NON-CASH ASSISTANCE a A. APPLICATION FORMS a B. COMPLETE APPLICATION a C. DATE OF APPLICATION a 10/ xvi

18 D. INTERVIEW REQUIRED a E. WHO MUST BE INTERVIEWED a F. WHO MUST SIGN b G. CONTENT OF THE INTERVIEW b H. DUE DATE OF ADDITIONAL INFORMATION c I. AGENCY TIME LIMITS c 1. Application Processing Limits c 2. MRT Time Limits c J. AGENCY DELAYS d K. PAYEE e L. REPAYMENT AND PENALTIES e M. BEGINNING DATE OF ELIGIBILITY e N. REDETERMINATION SCHEDULE e O. EXPEDITED PROCESSING e P. CLIENT NOTIFICATION e Q. DATA SYSTEM ACTION e R. REDETERMINATION VARIATIONS e 1. The Redetermination List e 2. The Date of the Redetermination Scheduling the Redetermination Completion of the Redetermination S. THE BENEFIT PROCEDURES IN THE MEDICAID APPLICATION PROCESS A. SPOUSES APPLY - ONE APPROVED, ONE PENDING / xvii

19 B. DEATH OF THE ONLY INDIVIDUAL PRIOR TO APPLICATION OR APPROVAL Who Must Be Interviewed And Sign The Application MRT Referral C. DOCUMENTATION AND REVIEW OF PENDING MEDICAID APPLICATIONS Instructions For Documentation For Pending Medicaid Applications Procedure For Review Of Pending Applications D. DETERMINING REASONABLE PERIOD OF TIME FOR SPENDDOWN ENTRY E. PRIOR ELIGIBILITY FOR CASES NOT CURRENTLY ELIGIBLE Approvals a 2. Denials a 3. Closures a F. CHANGING COVERAGE GROUPS AND REDETERMINATION PERIOD a G. COORDINATION BETWEEN THE DEPARTMENT AND THE FEDERALLY- FACILITATED MARKETPLACE (FFM) a 1. Applications Taken by the Marketplace b 2. Applications Taken by the Department c 3. Coordinating Between the Department and the Marketplace e H. APPLICATION PROCEDURES BEGINNING OCTOBER 1, e 1. Responsibilities of the Department e 2. Responsibilities of the Marketplace WV WORKS A. APPLICATION FORMS B. COMPLETE APPLICATION C. DATE OF APPLICATION / xviii

20 D. INTERVIEW REQURIED E. WHO MUST BE INTERVIEWED F. WHO MUST SIGN G. CONTENT OF THE INTERVIEW H. DUE DATE OF ADDITIONAL INFORMATION I. AGENCY TIME LIMITS J. AGENCY DELAYS K. PAYEE L. REPAYMENT AND PENALTIES M. BEGINNING DATE OF ELIGIBILITY N. REDETERMINATION SCHEDULE O. EXPEDITED PROCESSING P. CLIENT NOTIFICATION Q. DATA SYSTEM ACTION R. REDETERMINATION VARIATIONS Redetermination List Scheduling Interviews Completion Of The Redetermination Overdue Redeterminations S. THE BENEFIT The WV WORKS Benefit Diversionary Cash Assistance (DCA) The Medical Card Electronic Benefits Transfer (EBT) T. PERSONAL RESPONSIBILITY CONTRACT (PRC) / xix

21 U. SELF-SUFFICIENCY PLAN (SSP) Initial SSP First Full SSP Subsequent Changes to the SSP Domestic Violence Consideration V. RIGHTS OF APPLICANTS AND PARTICIPANTS WITH DISABILITIES W. ORIENTATION FORMER WEST VIRGINIA FOSTER CHILDREN A. APPLICATION PROCESS B. COMPLETE APPLICATION C. DATE OF APPLICATION D. INTERVIEW REQUIRED E. WHO CAN BE INCLUDED ON THE SAME APPLICATION F. WHO MUST SIGN G, CONTENT OF THE INTERVIEW H. DUE DATE OF ADDITIONAL INFORMATION I. AGENCY TIME LIMITS J. AGENCY DELAYS K. PAYEE L. REPAYMENT AND PENALTIES M. BEGINNING DATE OF ELIGIBILITY N. REDETERMINATION SCHEDULE O. EXPEDITED PROCESSING P. CLIENT NOTIFICATION / xx

22 Q. DATA SYSTEM R. REDETERMINATION SCHEDULE AND SPECIAL PROCEDURES Redetermination Schedule Special Procedures Rolling Renewals S. THE BENEFIT T. PERSONAL RESPONSIBILITY CONTRACT (PRC) U. ORIENTATION APPENDIX A COMMONLY USED ACRONYMS AND ABBREVIATIONS... A-1 APPENDIX B GUIDE FOR SELF-SUFFICIENCY PLAN... B-1 APPENDIX C EFFECTIVE DATE OF TANF STATE PLANS... C-1 APPENDIX D WV WORKS LIST OF LOCAL SERVICES TEMPLATE... D-1 APPENDIX E PUBLIC FORMS... E-1 DFA-RR-1, Rights & Responsibilities DFA-2, Application / Redetermination DFA-PAC-4, Medicaid Redetermination DFA-QSQ-1, QMB / SLIMB / QI-1 DFA-UH-5 Application for Undue Hardship Waiver DFA-SNAP-1 Application for SNAP DFA-SLA-S1 Supplement to Application for Health Coverage DFA-SLA-1 Application for Health Coverage & Help Paying Bills DFA-SLA-2 Application for Health Coverage & Help Paying Bills (Short Form) APPENDIX F WORKER RESPONSIBILITIES... F-1 APPENDIX G COUNTY COORDINATOR RESPONSIBILITIES... G-1 APPENDIX H BCF STATE COORDINATOR RESPONSIBILITIES... H-1 11/ xxi