State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

21-03 Version of 44.3 Treatment Needs Question for Childless Adults

Note

The premium and treatment needs question policies in Chapter 44 are not in effect due to the COVID-19 public health emergency. They will be re-implemented after the temporary policies related to the COVID-19 public health emergency are no longer in effect. Effective dates have been removed from this chapter. The chapter will be updated with new effective dates when the policies are re-implemented.

The treatment needs question is a screening tool that helps determine whether or not an applicant or member has used drugs in ways that have caused problems for them or their family, and if they are open to getting help for drug use.

Childless adults will be required to answer the treatment needs question as a condition of eligibility. A treatment needs question must be answered:

• For new applications, the requirement will apply for applications with a filing date on or after the policy effective date.
• For renewals, when the requirement applies depends on the status of the renewal:
  • If it is a renewal either submitted early or late, the requirement applies as of the policy effective date.
  • If it is a timely renewal, the requirement applies to renewals due on or after the end of the next calendar month after the policy effective date (impacting benefits starting in the first month of the new certification period).
• If a health care member becomes a childless adult during a certification period that starts after the policy effective date. This includes the member joining an existing childless adult assistance group.

During annual renewals, childless adults must answer the treatment needs question.

Example 1

Note: This example assumes a February 1 policy effective date. Anna is a childless adult currently enrolled in BadgerCare Plus. Her certification period began in August. On February 18, Anna submits an early health care renewal. Because Anna is submitting an early renewal after the policy effective date, she will be subject to the new policies and must answer the treatment needs question as part of her renewal for health care.

 

Example 2

Edith is a childless adult currently enrolled in BadgerCare Plus. Her certification period began prior to the policy effective date. Edith must answer the treatment needs question as part of her next renewal for health care after the policy effective date.

 

Example 3

Note: This example assumes a February 1 policy effective date. Brad is currently enrolled in BadgerCare Plus as a parent, along with his son Oliver. Brad completes a renewal for him and Oliver in April. Because he is a parent, the childless adult policies do not apply. Brad reports that Oliver has left the household in July, so Brad becomes a childless adult. Brad must answer the treatment needs question to remain eligible for BadgerCare Plus.

The childless adult will not need to answer a treatment needs question or affirm an existing response if they fall under any of the following:

• Has a verified status as a tribal member, child or grandchild of a tribal member, or individual who is eligible to get Indian Health Services
• Has a verified disability
  • A childless adult is considered to have a verified disability only if they have been determined by the Wisconsin Disability Determination Bureau (DDB) to be disabled, MAPP disabled, or by the DDB or the IM agency as presumptively disabled.
• Has resided in or is expected to be residing in an institution for at least 30 days  
• Is deceased
• Is incarcerated in jail or prison

Childless adults who are not required to answer the treatment needs question may voluntarily do so.

44.3.1 Answering the Treatment Needs Question

The treatment needs question will collect a self-attested answer to a question about substance abuse and desire for treatment.

If the treatment needs question is not answered (either answered “Yes” or “No”) the response does not meet the requirement for BadgerCare Plus eligibility. Health care eligibility cannot be denied or terminated for failure to sign the treatment needs question.

Whether the person responds Yes or No to the treatment needs question does not affect their eligibility for health care. But the response will be used to determine whether a referral should be made to a provider for substance use disorder (SUD) treatment:

• If the answer is NO, the childless adult has met the treatment needs question requirement and no further action is taken.
• If the answer is YES, the childless adult has met the treatment needs question requirement.
  • If they are enrolled in a health maintenance organization (HMO) or managed care organization (MCO), the HMO or MCO will be notified of their response to help them get into treatment.
  • If they are exempt from HMO or MCO enrollment, they will be provided information about accessing treatment.

The treatment needs question response will also be used to determine whether the member qualifies for a reduction in the monthly premium. If the member answers “Yes” to the question, they will receive a premium reduction.

44.3.2 Who Can Answer the Treatment Needs Question

Each childless adult must answer a treatment needs question. In addition to the childless adult, any of the following may answer the treatment needs question on behalf of all childless adults in the household:

• Primary person
• Spouse
• Authorized representative
• Financial power of attorney
• Legal guardian over the estate
• Someone authorized by the individual

44.3.3 Submitting the Treatment Needs Question

Childless adults will have several different ways to submit a response to the treatment needs question:

1. Online as part of ACCESS and MyACCESS
2. Phone or in person through the IM worker
3. The Treatment Needs Question paper form (F-02547) (available through the Department of Health Services’ Forms Library or attached to the Verification Checklist)

Childless adults will be able to answer a new treatment needs question at any time.

44.3.4 Real-Time Eligibility and Administrative Renewals

Childless adults who answer the treatment needs question as part of the ACCESS application can have their eligibility determined through Real-Time Eligibility (RTE).

For the first administrative renewal after implementation, childless adults may be administratively renewed, but will be asked to answer the treatment needs question separately in order to keep their eligibility. For subsequent administrative renewals, where a treatment needs question response is on file, the childless adult will be asked to report if their treatment needs question response has changed.

44.3.5 Treatment Needs Question Notification

The Case Summary will identify whether each childless adult has answered the required treatment needs question. However, each childless adult’s response to the treatment needs question will not be printed on the Case Summary in order to protect this sensitive information. Instead, a PIN-based summary will be mailed to each childless adult with their own treatment needs question response. This summary will be sent any time a Case Summary (including an Administrative Renewal Case Summary) is generated.

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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