13-02 Version of 25.3 Where to Apply

25.3 Where to Apply

25.3.2 Intercounty Placements 25.3.3 Applications Outside Wisconsin 25.3.4 Applications Received from the Federal Marketplace

25.3.1 Where to Apply Introduction

The applicantA request for BadgerCare Plus coverage. The request must be on the Department's or Federally-facilitated Marketplace’s application, registration form or account transfer (from Federally-facilitated Marketplace) and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. must apply in the county in which he or she resides.

The agency (county/tribe or consortia) of the applicant’s county of residence should process the individual’s application.

The applicant’s county of residence at the time of admission must receive and process applications for persons in these state institutions:

Northern, Central, and Southern Centers.
Winnebago and Mendota Mental Health Institutes.
The University of Wisconsin Hospital.

When an applicant contacts the wrong agency, redirect him or her to the consortium or tribal agency responsible for processing the applicationA request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. immediately. Anytime an application is received in the wrong consortium or tribal agency, it must be date stamped and redirected to the agency responsible for processing that application no later than the next business day. The filing date remains the date originally received by the wrong consortium or tribal agency.

25.3.2 Intercounty Placements

When a county 51.42 board, 51.437 board, human services department or social services department places a person in a congregate care facility that is located in another county, the placing county remains responsible for determining and reviewing the applicant’s BadgerCare Plus eligibility. A congregate care facility is a:

Child care institution.
Group home.
Foster home.
Nursing home.
Adult Family Home ( AFH ).
Community Based Residential Facility ( CBRF ).
Any other like facility.

The placing county may request the assistance of the receiving county in completing applications for persons who are not enrolled in BadgerCare Plus and renewals for BadgerCare Plus members. The receiving county must then forward the information to the placing county. The placing county remains responsible for determining the applicant’s eligibility. If the placing county requests assistance from the receiving county, the placing county must provide the other agency with:

The applicant’s name, age, and SSNSocial Security number .
The date of placement.
The applicant’s current BadgerCare Plus status.
The name and address of the congregate care facility in which the applicant has been placed.
The name of the county and agency making the placement.

When there is a dispute about responsibility, the social or human services department of the receiving county may initiate referral to the Department of Health Services' Area Administration office for resolution. Pending a decision, the county where the person is physically present must process the application, any changes and renewals.

25.3.3 Applications Outside Wisconsin

Generally, an application should not be taken for a resident of Wisconsin when he or she is living outside of Wisconsin. An exception is when a Wisconsin resident becomes ill or injured outside of the state or is taken out of the state for medical treatment. In this case, the application may be taken, using Wisconsin’s application forms (25.1), by the public welfare agency in the other state. The forms should be forwarded to the welfare agency in the other state. The Wisconsin IM agency determines eligibility when the forms are returned.

25.3.4 Applications Received from the Federal Marketplace

The Federally-faciliated Marketplace (the Marketplace or the Exchange) will begin sending applications to DHS through an account transfer process for individuals the Markeplace assesses as potentially eligible for BadgerCare Plus or Medicaid. Such applications are considered full applications for all "insurance affordability programs" including BadgerCare Plus and should be appropriately processed. The 30 day processing requirement begins on the day that the account is received by the local agency or the next business day if received after normal operating hours or on weekends or holidays. If eligible, the individual's benefits will begin on the first day of the month the application was filed at the Marketplace, not the date that the application was received by the agency. If the individual requests backdating, their eligibility will be backdated for up to three months from the first day of the month the application was filed at the Marketplace.

If a paper application from the Marketplace is mailed to a consortium or tribal agency, the IM worker should consider that application as an application for BadgerCare Plus and/or Medicaid and process it.

This page last updated in Release Number: 13-02

Release Date: 10/25/13

Effective Date: 10/01/13