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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
A renewal is the process during which all eligibility factors subject to change are reexamined and it is determined if eligibility continues. The group’s continued eligibility depends on its timely completion of a renewal and verification of required information. Each renewal results in a determination to continue or discontinue eligibility.
The first required eligibility renewal for a BadgerCare Plus case is 12 months from the certification month, except for the following:
For manually certified BadgerCare Plus cases, make sure the member receives a timely notice of when the renewal is due.
Review Dates for Time-Limited Benefits
BadgerCare Plus members are required to complete a renewal no earlier and no later than 12 months from their certification period. People whose benefits are time-limited (CENs, pregnant women, people who have met a deductible, or people in an extension) are required to complete a renewal at the end of their time-limited benefit unless they are on a case with other open BadgerCare Plus assistance groups. In this situation:
Workers can complete an early renewal only if the member requests an early renewal. Once the member requests an early renewal, the renewal must be completed.
| Note | Shortening certification periods in an attempt to balance agency workload is not permissible. |
Most health care renewals received within three months of the renewal month can be processed as a late renewal instead of requiring a new application. This policy applies to the following subprograms:
The policy applies to members receiving health care benefits based on a met deductible, but not to members with an unmet deductible.
Late renewals are only permitted for people whose eligibility has ended because of lack of renewal, and not for other reasons. Members whose health care benefits are closed for more than three months because of lack of renewal must reapply.
Agencies should consider late submission of an online or paper renewal form or a late renewal request by phone or in person to be a valid request for health care. The new certification period should be set based on the receipt date of the signed renewal. If verification is required during the completion of a late renewal, the member has 10 days to provide it.
| Example 1 |
Jenny’s renewal is due on January 31, 2016. She submits an online renewal via ACCESS on March 15, 2016. If the renewal is processed on the same day and verification is requested, the verification would be due on March 25, 2016. If she provides verification on or before this due date and meets all other eligibility criteria for BadgerCare Plus, her eligibility and certification period would start on March 1, 2016. Her next renewal would be due February 28, 2017. |
| Note |
The three-month period starts after the month the renewal was due. It does not restart when a late renewal has been submitted. If Jenny submits her renewal on March 15 but does not provide verification until May, she will need to reapply after the three-month period that started with her January renewal date. |
If the BadgerCare Plus renewal was completed timely, but requested verifications were not provided as part of the renewal, BadgerCare Plus can reopen without a new application if these verifications are submitted within three months of the renewal month. The submission of the renewal-related verifications is considered a request for health care. Only the missing verifications must be provided. However, the verifications must include information for the current month of eligibility. If verification is submitted for a past month, a new Verification Checklist must be generated to request the current verification, allowing 10 days to submit the verification.
| Example 2 |
Jenny’s renewal is due on January 31, 2016. She completes her renewal on January 20, 2016, and a Verification Checklist is generated requesting income verification for the 30 days prior to January 20. Jenny does not submit the requested verification, and her BadgerCare Plus eligibility is terminated as of January 31, 2016. On April 27, 2016, she submits her paystubs for April 10 and April 24. If she meets the eligibility criteria for BadgerCare Plus, her certification period will start on April 1, 2016, and her next renewal will be due March 31, 2017. If she had submitted the verification of her income for January, a new Verification Checklist should be generated asking for verification of her current income for April. |
If a member has a gap in coverage because of their late renewal, they may request coverage of the past months in which the gap occurred. Backdated coverage under the late renewal policy is available to all BadgerCare Plus members who meet program rules, including children who would not otherwise qualify for backdated coverage because their income is too high (see Section 25.8.1 Backdated Eligibility). However, this does not change the rules for backdating at application.
If a member requests coverage for past months during a late renewal, they must provide all necessary information and verifications for those months (including verification of income for all months requested) and must pay any required premiums to be covered for those months.
Based on federal requirements, health care eligibility must be redetermined once every 12 months based on information available to an agency. Agencies cannot require information from health care members during an annual renewal unless the information cannot be obtained through an electronic data exchange or the information from the electronic data exchange is not reasonably compatible with the information on file. The process of using electronic data exchanges for renewals is referred to as the administrative renewal process.
If information from electronic data exchanges validated information about a member’s income as currently recorded in CARES, additional information about income cannot be requested from the member at renewal. This includes member-reported information about earned income that is found to be reasonably compatible with earned income information obtained from SWICA and FDSH data exchanges, as well as any information about unearned income verified through SSA or UIB data exchanges. Unless reported otherwise, it is assumed during the administrative renewal process that household composition and tax filing status have not changed.
| Note | Information on administrative renewals that is specific to childless adults is described in Section 44.3.4 Real Time Eligibility and Administrative Renewals. |
To be considered for an administrative renewal, a case must be due for renewal in the following month and have one or more qualifying BadgerCare Plus, FPOS, or EBD Medicaid assistance groups open, including health care assistance groups open with a suspended status.
BadgerCare Plus and FPOS can be administratively renewed if all members on the case have:
BadgerCare Plus and FPOS cannot be administratively renewed if any members on the case have or are:
Additionally, BadgerCare Plus cannot be administratively renewed if any members on the case have or are calendar year tax dependent(s) for a past year.
BadgerCare Plus and FPOS also cannot be administratively renewed if anyone on the case is receiving EBD Medicaid, Medicaid Purchase Plan (MAPP), or Medicare Savings Program (MSP) benefits and has any of the exclusions for those programs, found in the Medicaid Eligibility Handbook, Section 3.1.5.2.2 Medicaid Cases that Cannot be Administratively Renewed.
Health care or FPOS will not be successfully administratively renewed if any of the following occur during the administrative renewal process:
The administrative renewal process begins in the 11th month of a member’s certification period. CARES determines who qualifies for an administrative renewal, verifies and updates information based on data exchanges, tests employment income and SWICA and FDSH results for reasonable compatibility, and runs through batch eligibility (see Process Help, 4.7 Administrative Renewals).
Cases that have a successful administrative renewal will have health care or FPOS eligibility redetermined and will be recertified for a new 12-month certification period. The member will be sent a letter notifying them that their eligibility has been renewed, along with a case summary. The member must review the information on the case summary and report if any of the information is incorrect within 30 days of the mailing date. The member can make the changes on the summary and mail or fax it to their agency, or they can report their changes through ACCESS or by phone. If all of the information on the case summary is correct, the member will not need to take any other action. The member will be sent a Notice of Decision.
Benefits may not be terminated or reduced (for example, being charged a greater premium amount) during the administrative renewal process based solely on information obtained from a data exchange. This includes information obtained from SSA, UIB, FDSH, or SWICA data exchanges. If benefits cannot be continued through the administrative renewal process, the case will be excluded from the administrative renewal process, and the member will be sent a 45-day renewal letter and a PPRF. The member will have at least 30 days to complete, sign, and return the PPRF or to complete their renewal by phone, in-person, or through ACCESS.
Cases that have a successful administrative renewal remain subject to change reporting requirements. The administrative renewal letter instructs a member to review and report any changes to the attached case summary and informs them of the potential consequences for not reporting those changes. If a member does not correct information that is wrong and gets benefits that they should not get, the member is liable for any resulting overpayments. In addition, administrative renewal cases will receive a Notice of Decision that identifies program-specific change reporting requirements, as well as the potential consequences for not reporting changes timely. Changes reported for a case that has undergone an administrative renewal should be processed under existing policy.
Changes reported as part of a renewal for another program should also be applied to health care.
This page last updated in Release Number: 21-01
Release Date: 3/29/2021
Effective Date: 3/29/2021
The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.
Publication Number: P-10171