37.3 HCBW Medicaid CARES Processing for the CLTS Waiver Program

When a child who is functionally eligible for the CLTS program is referred to IM, he or she must first be tested for eligibility using HCBW rules. To be eligible for HCBW Medicaid, the child must be both Medicaid-eligible and functionally eligible. To determine eligibility for HCBW, only the child’s income is counted. Effective 10/01/09, assets are no longer counted for disabled or institutionalized children. Since assets are disregarded, there can be no divestment in a HCBW Medicaid case for a child.

If an applicant or participant is ineligible for HCBW, he or she must then be tested for BadgerCare Plus.

HCBW requests must be processed differently depending on whether there are any other people on the case who are requesting health care. See Process Help Section 9.7 Home and Community-Based Waiver Medicaid for Children's Long-Term Support for processing instructions.

37.3.1 HCBW CARES Processing for Minor Children

To facilitate the application and renewal process and reduce the duplication of verification requests that could cause a burden to families who are applying for multiple programs, CWA staff working with a family whose child is functionally eligible and requesting HCBW will submit the following information to the IM agency.

For initial applications, CWAs work with families to complete and submit:

A valid application for health care (see Section 2.4 Valid Application), including the Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, F-10129
Home and Community-Based Waiver Medicaid Enrollment for the Children’s Long-Term Support Waiver Program, F-02319
Medicaid Waiver Eligibility and Cost Sharing Worksheet, F-20919
Verification of the child’s income, if any

For annual HCBW renewals, the family must submit a completed health care renewal (for example, a PPRF) and CWA staff will submit:

Home and Community-Based Waiver Medicaid Enrollment for the Children’s Long-Term Support Waiver Program, F-02319
Medicaid Waiver Eligibility and Cost Sharing Worksheet, F-20919
Verification of the child’s income, if any

37.3.2 HCBW CARES Processing for Young Adults 18 – 21

Individuals can be eligible for the CLTS Waiver Program and HCBW Medicaid through age 21. When a CLTS Waiver Program applicant or member reaches 18 years old and their source of Medicaid is HCBW, they must apply for HCBW Medicaid as the primary person. Federal and state privacy and confidentiality protections prevent the parents of adults from automatically having access to protected information; therefore, these young adults must apply as the head of their own IM case.

When individuals ages 18 – 21 require HCBW Medicaid, CWA staff submits the following to IM:

Wisconsin Medicaid, BadgerCare Plus, and Family Planning Only Services Registration Application, F-10129
Home and Community-Based Waiver Medicaid Enrollment for the Children’s Long-Term Support Waiver Program Form, F-02319
Medicaid Waiver Eligibility and Cost Sharing Worksheet, F-20919
Verification of the young adult’s income, if any.

The renewal process is the same for all HCBW members (see Section 37.3.1 HCBW CARES Processing for Minor Children).

This page last updated in Release Number: 19-01
Release Date: 4/19/2019
Effective Date: 4/19/2019

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