23-01 Version of 28.3 Unrecoverable Overpayments

Susan and her daughter Kathy are open for BadgerCare Plus. Susan reported a change in income on April 1. The worker did not process the change until April 28, so it was not effective until June 1. There is no overpayment for May since the change was reported timely, but not acted on by the worker until after adverse action .

Richard became eligible for BadgerCare Plus as a childless adult in March of last year and had no countable income. At his renewal in February, Richard reports that he has been working since April of last year. Verification shows that Richard’s salary of $2,500 per month came to a countable income total of $22,500. Although Richard exceeded his reporting limit in April, the worker must look at what would have happened had he reported the change timely when determining whether an overpayment occurred.

The worker finds that Richard was required to report his change in income no later than May 10. Since verification of his actual income for last year shows that he was over the annual income limit for gap filling, there is an overpayment for June 1 through December 31.

The worker then evaluates the overpayment for January and February of the current year. So far, Richard has only received $5,000 in countable income. Because the IM agency doesn't have any information to indicate that Richard’s job will not continue for the rest of the year, he would not be found eligible under gap filling rules. However, for benefit recovery purposes, he hasn't yet exceeded the 100% of the FPL annual income limit, so the IM agency can't say definitively that he wouldn't have been eligible under gap filling rules. The worker can't establish an overpayment for his eligibility in the current year until Richard’s income has been found to be over the annual limit for gap filling coverage. The worker must manually track the case to review the case in January of the next year. 

In January of the next year, the worker reviews Richard’s case for a potential overpayment from January 1 through February 28 of last year and determines his annual income. His earned wages were $6,700 for the first quarter, $5,100 for second quarter, and $4,250 for the third quarter. His fourth quarter wages haven't been updated yet. Based on the information available, Richard has surpassed the annual income limit for last year. His total wages through the third quarter total $16,050. There is an overpayment for the period of January 1 through February 28.

Kimmy was eligible for BadgerCare Plus as a childless adult beginning in October of last year. In August of this year, the worker is processing a discrepancy created in July showing that Kimmy has unreported wages from the first quarter of this year. The worker requests verification from Kimmy, which shows that she works 32 hours per week and earns $15 per hour for a total of $1,920 per month.

Had Kimmy reported her income timely by February 10, she would have been over the monthly income limit for BadgerCare Plus. SWICA shows that Kimmy has already earned $14,700 this year. Since the worker has evidence that Kimmy has surpassed the annual income limit for this year, the worker can proceed with establishing an overpayment for March 1 through June 30.

Effective February 1, Delia was eligible for BadgerCare Plus as a childless adult with an assistance group size of one. In August, she reports that her 8-year-old daughter, Zoe, has moved into the household, and she plans to claim Zoe as a tax dependent. Beginning in September, Delia is determined eligible as a parent or caretaker adult with an assistance group size of two.

In February of the next year, a worker is reviewing a SWICAState Wage Information Collection Agency discrepancy showing that Delia began a job in March of last year, which she did not report. The worker verifies that Delia’s income is over the monthly income limit for April through November and sees that she had an annual income total of $14,700 for last year. For part of that period, Delia was in a group size of one and surpassed the annual income limit for a group size of one.

However, starting in September of last year, Delia’s group size increased when Zoe was added to the case. Taking into consideration the change in group size during the overpayment period and Delia’s annual income ($14,700) compared to the annual FPL for a group size of two, there is no overpayment since Delia will be ending the tax filing year with a group size of two and will be below the annual income limit for a group size of two.

Cameron is a single childless adult with an income limit of $1,215 for BadgerCare Plus. He applies for BadgerCare Plus in January and reports that his earnings are $1,200 per month. The monthly earned income amount reported by Equifax is $1,300 per month. Because Cameron’s reported income is below the income threshold and the Equifax-reported income is above the income threshold, the 20% threshold test is applied. The income reported by Equifax ($1,300) is less than the 20% threshold amount (120% of $1,200, or $1,440), so his reported information is reasonably compatible, and he does not need to verify his earned income. 

In April Cameron applies for FoodShare. Cameron must provide verification of his earned income when applying for FoodShare. His verified earned income is $1,400, and it is discovered that he failed to report in February that his income increased to $1,400. This amount is over the BadgerCare Plus income limit of $1,215, so Cameron is no longer eligible for BadgerCare Plus. However, this amount is not more than 20% greater than the income amount of $1,200 that was used to determine that he was eligible for BadgerCare Plus in January. Therefore, he cannot be subject to an overpayment.

The amount that is 20% greater than $1,200 is $1,440. If Cameron’s income had increased to an amount greater than $1,440 and he failed to report the increase, he could have been subject to an overpayment.