|
State of Wisconsin |
Release 24-03 |
The following items must be verified for BadgerCare Plus:
Unless determined questionable, self-declaration is acceptable for all other items.
Social security numbers (SSNs) must be furnished for household members requesting BadgerCare Plus unless they are exempt from the SSN requirement (see Section 6.1.1 Social Security Number Requirements). SSNs are not required from non-applicants, including outside of the home tax dependents and co-filers.
An applicant is not required to provide a document or Social Security card. They only need to provide a number, which is verified through the CARES SSN validation process.
If the SSN validation process returns a mismatch record, the member must provide the Social Security card or another official government document with the SSN displayed. If an applicant does not yet have an SSN, they must be willing to apply for one.
Agencies must assist any household that requests help with applying for an SSN for any applicant or member who does not have one. “Assisting the applicant” may include helping with filing the SS-5 SSN Application form, obtaining a birth certificate on behalf of the applicant, or assisting with obtaining another document needed to apply for the SSN.
Health care eligibility may not be delayed if the person is otherwise eligible for benefits and any of the following are true:
In cases where an application for SSN has been filed with the Social Security Administration, an SSN must be provided by the time of the next health care renewal for the case or health care eligibility will be terminated for that individual. In addition, if eligibility for another program pends for provision of an SSN and the SSN application date on file is six months or older, eligibility for health care will also pend. Members will have 20 days to provide an SSN, but if they do not, health care eligibility must be terminated.
Even when U.S. citizenship cannot be verified due to a lack of a verified SSN, health care benefits should not be delayed for lack of an SSN during the reasonable opportunity period for verification of U.S. citizenship (see Section 4.2.4.4 Reasonable Opportunity Period for Verification of Citizenship).
The member should be informed if the SSN validation process indicates another individual is using the same SSN. The member should contact the Social Security Administration and request they conduct an investigation. The IM worker cannot provide the member with any information that would identify the individual who is using the member's SSN.
If the Social Security Administration finds that the SSN has been used fraudulently it may:
Recommend further action be taken, or
Provide the member with the information on the fraudulent action so that the member may pursue action through the legal system.
Verify the SSN only once.
A parent of a newborn may begin an SSN application on the newborn’s behalf while still in the hospital.
Do not require an SSN to be furnished or applied for on behalf of a newborn determined continuously eligible (see Section 8.2 Continuously Eligible Newborns) for BadgerCare Plus. Accept the parent’s statement about the existence and residence of the newborn.
Do not require or verify SSNs of people applying for BadgerCare Plus Emergency Services only (see Chapter 39 Emergency Services).
Do not require or verify SSNs of people applying for the BadgerCare Plus Prenatal Program (see Section 41.1 BadgerCare Plus Prenatal Program).
Verification of the individual’s immigration status is done through the FDSH or the Systematic Alien Verification for Entitlement (SAVE) system. Women applying for BadgerCare Plus Prenatal Program (see Chapter 41 Badger Care Plus Prenatal Program) and people applying for Emergency Services (see Chapter 39 Emergency Services) do not have to verify their immigration status.
Applicants who are otherwise eligible and are only pending for verification of immigration status must be certified for health care benefits during the reasonable opportunity period (see Section 4.3.2.2 Reasonable Opportunity Period for Verification of Immigration Status).
Verification is not required for pregnancy unless the worker has information that contradicts the applicant or member’s statement.
If pregnancy information is questionable, acceptable verification sources are:
| Note |
If pregnancy must be verified, the BadgerCare Plus temporary enrollment card cannot be used as a source of verification, as pregnancy will not be verified for Temporary Enrollment for Pregnant Women (see Chapter 32 Presumptive Eligibility). |
Medical expenses used to meet a deductible must be verified. The expense amount, any third party liability amount and date of service must all be verified.
If verification is not provided, do not include the expense to determine when a deductible has been met. Do not deny or terminate eligibility for failure to provide the requested verification.
If the applicant or member states they have an agent with power of attorney, documentation of the power of attorney appointment is required. Only an agent with durable power of attorney for finances is considered to have power of attorney for health care programs. “Durable” means that the power of attorney continues even if the applicant or member becomes incapacitated.
If the applicant or member states they have a legal guardian, documentation of the court-ordered guardianship is required.
If the applicant or member states they have a conservator, documentation of the court-ordered conservatorship is required.
If verification is not provided, do not grant the claimed agent with power of attorney, guardian, or conservator access to case notices or follow any direction provided by that individual unless they are an authorized representative. Do not deny or terminate eligibility for failure to provide the requested verification.
Verification of any type of countable income is required for all members with the exception of expected annual income for eligibility determinations using gap filling rules and certain earnings of prison or jail inmates (see Section 9.9.6.1 Prison or Jail Job). Even though verification of expected annual income is not required, the reported expected annual income must be validated by the agency using all available information (see Section 16.9 Gap Filling).
Income must only be verified using electronic data sources, except when the information cannot be obtained through an electronic data source or information from the data source is not reasonably compatible with what the applicant or member has reported (see Section 9.12 Reasonable Compatibility for Health Care).
Accept a member’s or suspended member’s statement and do not require verification of income earned by an inmate from a prison or jail job that pays less than minimum wage, such as jobs through Badger State Industries (BSI) (see Section 16.4.1 Specially Treated Wages, #7 Prison or Jail Job).
This policy does not apply to work release jobs or other employment an inmate has that pays minimum wage or more. Income from those jobs should be verified and counted according to regular income verification policy.
If an applicant or member claims to be a live-in care provider with tax-exempt income, workers must provide the applicant or member with a Verifying Tax-Exempt Income for Live-in Care Providers form (F-02193) and ask them to complete it to attest to meeting the criteria that makes this income exempt. If there is a reason to question some or all of the information provided on the form, workers may seek additional verification.
Verification of access to health insurance is required at the following times, unless the individual has already verified health insurance access within the last 12 months with the same employer:
BadgerCare Plus Application and Renewal
Person Add - if adult (age 18 or over) is employed and part of the BadgerCare Plus test group
When an adult (age 18 or over) in the BadgerCare Plus test group gets a new job
When a change is processed causing total household income to exceed the following FPL thresholds:
Children ages one through five (up to age six), 191% of the FPL
Children ages six to 18, 156% of the FPL
It is not the client’s responsibility to verify access to employer-sponsored health insurance. For the majority of BadgerCare Plus applicants and members the EVHI database will be used to verify insurance access. Information gathered from employers is stored in the database. The verification will be returned based on the employer details entered on the employment page. It will be critical for Income Maintenance workers to enter the correct FEIN number and all other employment details for each employment sequence so that all employers are correctly identified in the EVHI database.
If the employment details are not complete enough to verify access, the applicant will be sent a letter from the state requesting more information and the case will pend.
| Example 1 |
Mary is applying for BadgerCare Plus for herself and her two children. Mary’s employer has verified that permanent full-time employees and their children have access to health insurance; however, temporary employees do not. Mary did not indicate whether she is a permanent or temporary employee. Since that information is necessary to verify access to health insurance using the database, she will be sent a letter requesting the information. |
If the employer has not provided information about the health insurance they offer to their employees, the BadgerCare Plus eligibility will pend and a request will be sent from the State to the employer requesting that the information be provided.
BadgerCare Plus eligibility can pend up to the end of the 30-day application processing period. At that point, regardless of whether the employer has responded or not, eligibility must be confirmed. If the employer has not responded assume there is not access to employer sponsored health insurance.
BadgerCare Plus will not be terminated or denied due to an employer failure to respond to a request for verification of health insurance access. If BadgerCare Plus eligibility begins and an employer later responds to the verification request indicating that health insurance access is available to the employee, BadgerCare Plus eligibility will be terminated with adequate notice of adverse action. There will be no overpayment liability for the applicant.
Other types of verification can be used to document access to employer sponsored health insurance. If a BadgerCare Plus applicant or member needs medical services, agencies may use other contacts with employers in these situations to speed the verification process. Other forms of verification include:
Verification of Tribal membership, descent from a Tribal member, or eligibility to receive Indian Health Service (IHS) services is required in order to receive an exemption from paying BadgerCare Plus premiums and copayments (see Section 38.2.2 Copay Exempt Populations). Acceptable verification sources include:
If verification is not provided, do not indicate in CARES that the person is a Tribal member. Do not deny or terminate eligibility for failure to provide the requested verification.
People whose eligibility is determined using MAGI rules can claim pretax deductions to determine their MAGI taxable income. To claim a pretax deduction, verification of the amount is required. Verification sources such as pay stubs received during the last 30 days or other documentation from a person's employer can serve as acceptable documentation. See Section 16.3.2 Pretax Deductions for a list of pretax deductions.
If verification is not provided, do not include the deductions when determining eligibility. Do not deny or terminate eligibility for failure to provide the requested verification.
People whose eligibility is determined using MAGI rules can claim certain tax deductions from the IRS 1040 Form, regardless of whether or not they file taxes (see Section 16.3.3 Tax Deductions). People who claim such deductions must provide verification that the expense is or was incurred. Verification could include:
If verification is not provided, do not include the deductions when determining eligibility. Do not deny or terminate eligibility for failure to provide the requested verification.
Verification of a person’s status as a Former Foster Care Youth is required only at initial application. Verify the status of the youth, including a youth from another state, with the local Child Welfare agency by using the BadgerCare Plus Former Foster Care Youth form (F-10184).
| Note |
It is not the applicant’s responsibility to verify their status. |
If a Child Welfare agency does not provide verification within 30 days of the application filing date, confirm the person as a Former Foster Care Youth if they are otherwise eligible. Once the person is verified as a Former Foster Care Youth, additional verification of that status is not required even if the person becomes ineligible for BadgerCare Plus at some point and later reapplies.
If the gross amount of pension and annuity income has been verified, but the taxable amount has not, the gross amount must be used in the BadgerCare Plus or FPOS budget calculation. The individual’s benefits will not be terminated or denied due to failure to verify the taxable amount. If neither the gross nor the taxable amount is verified, the individual’s benefits will be terminated or denied due to lack of verification.
Applicants and members who are incarcerated but allowed to leave jail under the Huber Law can become or remain eligible for full-benefit BadgerCare Plus if the reason for the release is to return home to care for their minor children (see Section 45.8.4 Huber Law for the Huber Law exemption criteria).
To qualify for the Huber Law exemption, verification that the applicant or member is returning home to care for minor children is required.
Acceptable verification sources include:
If the verification shows that the person is only allowed to leave jail under the Huber Law for a reason other than caring for a minor child, they are not eligible for the Huber Law exemption.
Verification of grants, scholarships, and fellowships counted as income is required. Verification of expenses, including tuition, required books, supplies, or equipment, or mandatory fees, that can be used to offset these counted income types is also required. See Section 16.5 #16 Student Financial Aids.
This page last updated in Release Number: 24-03
Release Date: 12/18/2024
Effective Date: 12/18/2024
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.
Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.
Publication Number: P-10171