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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
25.7.1 Non-Financial Requirements
Medicaid applicants who are infected with tuberculosis ( TB ) are non-financially eligible for TB-related Medicaid services.
Consider these persons to be in a special category of Medicaid. They are non-financially eligible for TB-related Medicaid if they are infected with TB, even if they are not blind, disabled, or over age 65. " ;Infected with TB” means that a physician has examined them and found that one or more of the following diagnoses apply to them:
Infected with latent or active TB.
Positive TB skin test.
Negative TB skin test, but a positive sputum culture for the TB organism.
Negative test for TB, but a physician certifies that they require TB-related drug therapy or surgical therapy or both.
A physician certifies that they require testing to confirm the presence or absence of TB.
Accept the member’s statement that they have one or more of the above conditions unless the information provided is questionable (20.4 Questionable Items). If questionable, accept any of the following as verification:
A physician's or registered nurse's written confirmation that the person has one or more of the above conditions.
Wisconsin Tuberculosis Record ( Form DPH 4756 ). This card identifies the person and the physician's diagnosis, and has on it the name and telephone number of the treatment provider.
Assets - The asset limit for one person is $2,000. Count assets the same as for other EBD AGs.
Income - The income limit for one person is $1,481. This is gross income . There is no net income test.
Deductible - TB-related AGs which fail the TB-related gross income test cannot become eligible for a Medicaid deductible.
If more than one person in the AG is TB-infected, test each person as a single individual with his/her own fiscal test group. Do not deem assets or income from any other member of the AG.
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Example 1: Mary and her spouse George are both applying for TB-related Medicaid. Test Mary and George as separate fiscal test groups. Do not deem assets or income from Mary to George or from George to Mary. Test Mary's assets against the asset limit. Test her income against the income limit for one person. Test George's assets against the asset limit. Test his income against the income limit for one person. |
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Example 2: There are three children in the Kraan family. All of the children have TB. Consider each child to be a separate fiscal test group. Test each child using only his/her own assets and income. Each child’s assets do not exceed the asset limit. Each child’s income limit does not exceed the income limit. Do not deem assets or income from the child’s parents or from any of his/her siblings. |
If only one person in the AG is TB-infected, and that person is a:
TB-infected minor or 18-year-old:
Test him/her in the Financial Tests for Disabled Minors. Add the parents' deemed assets and income to the minor or 18- year-old's assets and income. Test him/her against the asset limit and the gross income limit.
TB-infected adult with assets/income, and spouse with no assets/income:
Test the TB-infected adult's assets/income against the asset limit and the gross income limit.
TB-infected adult with assets/income, and spouse with assets/income:
Use the EBD-Related Determination Worksheet (WKST 06) to determine the spouse's assets and net income. Add these totals to the TB-infected person's assets and gross income. Compare this total to the asset limit and the gross income limit.
TB-infected adult with no assets/income, and spouse with assets/income:
Use the WKST 06 to determine the spouse's assets and net income. Compare these results to the asset limit and the gross income limit.
When using the WKST 06, disregard items 16-18. Replace item 19 with the TB-related income limit. Disregard item 20.
Persons who become eligible for TB-related Medicaid receive a Medicaid card that identifies them as eligible for only the following Medicaid services:
Prescribed drugs.
Physicians' services.
Laboratory and X-ray services, including services to diagnose and confirm the presence of infection.
Clinic services and federally qualified health care ( FQHC ) services.
Targeted case management services.
Services, other than room and board, designed to encourage completion of regimens of prescribed drugs by outpatients.
Services that are necessary as a result of the side effects of prescribed drugs for TB treatment.
QMB , SLMB , and QDWI recipients do not automatically qualify for TB-related Medicaid services. If they are eligible for EBD or Family Medicaid, they can receive TB-related services under regular Medicaid.
TB-related services provided for the treatment of an emergency medical condition (34.1 Emergency Services) may be covered for persons who do not meet citizenship requirements (7.3 Immigrants).
Determine TB-related AGs manually in the following way:
Determine Medicaid eligibility for all other subprograms in CARES. Do not confirm unless there is eligibility for a category of Medicaid that is not QMB, SLMB, or QDWI.
If there is only QMB, SLMB, or QDWI eligibility, test the person against the TB-related financial tests. Complete and return a F-10110 (formerly DES 3070) to HP Enterprise Services:
Mail: HP Enterprise Services
P.O. Box 7636
Madison, WI 53707
Fax: (608) 221-8815
If the member is eligible, certify him/her with a manual F-10110 (formerly DES 3070) form, medical status code of TR. Confirm all denials in CARES and allow the CARES generated notices to be sent. Send him/her a manual positive notice with the effective date of his/her eligibility for TB-related services.
If the person is not eligible for any Medicaid subprograms, including TB-related Medicaid, confirm all denials in CARES and allow the CARES generated notices to be sent. Send him/her a manual negative notice indicating that s/he is not eligible for TB-related Medicaid.
This page last updated in Release Number: 12-01
Release Date: 03/21/12
Effective Date: 01-01-12
The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 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-10030