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VA MEDICAID WORKS - Entitlement and Enrollment

Entitlement for Virginia's MEDICAID WORKS program is dependent upon meeting all of the program's financial eligibility requirements and non-financial eligibility requirements .

There is no retroactive coverage under MEDICAID WORKS. Coverage begins on the first day of the month following the month in which all requirements are met.

If the applicant has a future start date for employment, the effective date of eligibility can be no earlier than the first day of employment. However, unless employment begins on the first day of the month, MEDICAID WORKS enrollment will begin on the first day of the following month.

Eligibility for MEDICAID WORKS continues as long as the enrollee continues to:

·               be employed,

·               meet the definition of disability or blindness,

·               meet the age limitation (16 through 64 years old), and

·               does not exceed the income and resource limits for MEDICAID WORKS.

The individual's continuing eligibility must be re-determined at least every 12 months.

NOTE: Current MEDICAID WORKS regulations may potentially impact an enrollee's continuing eligibility for MEDICIAD WORKS in certain scenarios that effect unearned income. These may be changed in the future, but remain in effect as of January 2012.

1. If automatic COLA increases to SSDI cause an enrollee's total unearned income to exceed 80% of the Federal Poverty Level, the person will no longer be eligible for MEDICIAD WORKS.

2. Enrollees must, under the regulations, apply for Unemployment Insurance, which is considered unearned income. If the UI causes total unearned income to exceed 80% of the Federal Poverty Level, the person will no longer be eligible for MEDICIAD WORKS.

If the individual is no longer eligible for MEDICAID WORKS, the eligibility worker must determine whether the individual remains eligible in any other covered group. He or she must also determine whether the safety net rules apply.

If the individual is not eligible for Medicaid in any other covered group, coverage will be cancelled effective the first of the month following the expiration of a 10-day advance notice.

Also See:

Virginia MEDICAID WORKS - Overview

Virginia MEDICAID WORKS - Agreement

Virginia MEDICAID WORKS - Blindness and Disability

Virginia MEDICAID WORKS - Cost Sharing and Premium Payment

Virginia MEDICAID WORKS - Employment Considerations

Virginia MEDICAID WORKS - Financial Eligibility

Virginia MEDICAID WORKS - Good Cause Exceptions

Virginia MEDICAID WORKS - Non-Financial Eligibility

Virginia MEDICAID WORKS - Safety Net

VA MEDICAID WORKS - Work Incentive (WIN) Account

Source

Some information for this topic was drawn from the DMAS website at:
http://www.dmas.virginia.gov/downloads/pdfs/mb-FactSheet_Medicaid.pdf
http://www.dmas.virginia.gov/downloads/pdfs/rcp-medicaid_applicant_handbook.pdf

Additional information was drawn from Section M0320.211 of the Department of Social Services (DSS) Medicaid Manual.

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