State of Wisconsin Department of Health Services

HISTORY

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

17-03 Version of 8.2 Medical Support/ CSA Cooperation

8.2.1 Medical Support/Child Support Agency Cooperation

Unless the person is exempt, or has good cause for refusal to cooperate (see Section 8.3 Claiming Good Cause), each applicantA person who has submitted a request for coverage for whom no decision has been made regarding eligibility or memberA recipient of Medicaid; formerly referred to as a "client." that is referred, must, as a condition of eligibility, cooperate in both the following:

• Establishing the paternity of any child born out of wedlock for whom Medicaid, including Medicare Savings Programs, is requested or received
• Obtaining medical support for the applicant and for any child for whom Medicaid, including Medicare Savings Programs, is requested or received

Cooperation includes any relevant and necessary action to achieve the above. As a part of cooperation, the applicant may be required to:

1. Provide verbal or written information known to, possessed by, or reasonably obtainable by the applicant.
2. Appear as a witness at judicial or other hearings or proceedings.
3. Provide information, or attest to the lack of information, under penalty of perjury.
4. Pay to the CSAChild Support Agency any court-ordered medical support payments received directly from the absent parent after support has been assigned.
5. Attend office appointments as well as hearings and scheduled genetic tests.

Note:

The applicant or member is only required to cooperate if the child under their care is eligible for benefits funded under Title XIX. If the child’s Medicaid benefit is funded through any other source (Title XXI or GPR) the caretaker is not required to cooperate and can not be sanctioned for non-cooperation. Check the Medical Status codes to determine funding source. The CSA will monitor the child’s Medicaid funding source.

8.2.2 Failure to Cooperate

The CSA determines if there is non-cooperation for individuals required to cooperate. The IMincome maintenance agency determines if good cause exists (see Section 8.3.7 Determination). If there is a dispute, the CSA makes the final determination of cooperation. The member remains ineligible until he or she cooperates, establishes good cause, or cooperation is no longer required.

The following individuals are not sanctioned for non cooperation:

1. Pregnant women.
2. Minors.
3. Parents or caretaker relatives while the family is in a BadgerCare Plus Extension.

For a pregnant woman, failure to cooperate cannot be determined prior to the end of the month in which the 60th day after the termination of pregnancy occurs.

Note:

If the local CSA determines that a parent is not cooperating because court ordered birth costs are not paid, the parent or caretaker is not sanctioned.

 

Example 1:

Mary, a disabled parent, is applying for Medicaid for her and her son, Michael. She refuses to cooperate in obtaining medical support for Michael. Mary meets all other non-financial and financial criteria for Medicaid and EBD Medicaid. Mary is not eligible for EBD Medicaid or Medicaid, because she will not cooperate in obtaining medical support for Michael. Even though Mary has not cooperated in obtaining medical support for Michael, he remains eligible for Medicaid.

This page last updated in Release Number: 17-03
Release Date: 11/03/2017
Effective Date: 11/03/2017

---

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