36.3 Wisconsin Well Woman Medicaid Nonfinancial Requirement

36.3.1 WWWMA Introduction

The following are WWWMAWisconsin Well Woman Medicaid specific non-financial requirements:

Live in Wisconsin,
Meet general EBD citizenship and ID requirements.
Be under age 65.
Have been screened for breast or cervical cancer by the Well Woman Program, or enrolled in the Family Planning Waiver, CORE or Benchmark programs.
Be diagnosed for breast or cervical cancer, or certain pre-cancerous conditions of the cervix, as identified by the clinical screener.
Require treatment for the breast or cervical cancer, or pre-cancerous conditions of the cervix, as identified by the clinical screener.
Not be eligible for BadgerCare Plus without a premium or EBD MA.
Meet the insurance coverage requirements listed below in 36.3.2 Disqualifying Insurance Coverage

A woman is ineligible for WWWMA if she is currently covered by any one of the following:

Group health plans that cover treatment for her breast or cervical cancer,
Full benefit health insurance that covers treatment for her breast or cervical cancer,
Medicare Part A,
Medicare Part B,
BadgerCare Plus without a premium or any other category of full benefit Medicaid that covers her treatment for breast or cervical cancer (Note: An unmet deductible is not full benefit Medicaid),

Veteran's benefits/TRICARE that cover treatment for her breast or cervical cancer,
HIRSP,
Federal employee health plans,
Peace Corps health plans, or
Other full benefit private or public health care plans that provide cancer treatment as determined by her health care team.

The following health care benefits do not disqualify an applicantA person who has submitted a request for coverage for whom no decision has been made regarding eligibility from WWWMA:

Coverage only for accident or disabilityThe law defines disability for Medicaid as "The inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." income insurance, or any combination thereof,
Liability insurance including general liability insurance and automobile liability insurance,
Workers’ compensation or similar insurance, credit-only insurance,
Coverage for on-site medical clinics,
Other similar insurance coverage, under which benefits for medical care are secondary or incidental to other insurance benefits,
Indian Health Services,
Non-coverage of cancer treatment due to waiting period, or
Non-coverage of breast or cervical cancer treatment due to exclusion (max out) of cancer treatment in the policy.

Separate health insurance benefits that are not considered health insurance if offered separately are:

Limited scope dental or vision benefits, or
Benefits for long-term care, nursing home care, home health care, community-based care or any combination thereof.

Independent uncoordinated benefits are not considered health care insurance if offered as independent and/or uncoordinated benefits (for example,, coverage only for specified disease or illness, hospital indemnity or other fixed indemnity insurance).

Separate insurance policies are not considered health insurance if offered as a separate insurance (Wrap Around) policy:

Creditable coverage plans that do not cover treatment for the breast or cervical cancer due to a waiting period, exclusion or carve out restrictions.

Note: Medicare Parts A or B will disqualify an applicant from WWWMA eligibility.

This page last updated in Release Number: 09-03

Release Date: 06/05/09

Effective Date: 06/05/09