State of Wisconsin Department of Health Services

HISTORY

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

20-03 Version of 26.6 Reserved

26.6.1 MAPP Restrictive Re-enrollment Period Introduction

A MAPP member who fails to pay the premium on time will lose his or her MAPP benefits and will be subject to an RRP of three months, beginning with the month after the missing payment month. (For example, if the member does not pay the December premium by the due date (December 10), an RRP will be imposed at December adverse action from January to March). A MAPP member will be able to regain eligibility during the RRP if any of the following conditions are met:

• The member pays all past-due premiums by the last day of the RRP. Members must pay the overdue premium(s) that resulted in case closure, but do not have to pay the premium owed for the following month, unless the late payment is made after the benefit month.
• The member becomes eligible for MAPP without a premium (that is, the member’s gross monthly income is reduced to at or below 100 percent of the FPL). Note: The RRP will still run in the background and will be reinstated if the member’s income increases above 100 percent of the FPL during the RRP.
• The member is granted a temporary premium waiver for the duration of the RRP or makes the past due payments for any RRP months not covered by the temporary premium waiver.

Example 1:

Amy is eligible for MAPP with a premium. She misses her April MAPP premium payment and an RRP is imposed for May, June, and July. In May, she applies for and is granted a temporary MAPP premium waiver for April 1 through August 31. The RRP is lifted and Amy is eligible for MAPP with no premium effective April 1. She will be required to pay premiums again starting in September.

 

Example 2:

Lynn is eligible for MAPP with a premium. She misses her June premium payment and is placed in an RRP on July 1. Lynn pays for June and July’s premiums on July 30 to end her RRP and become eligible for MAPP. Her August premium is not due until August 10, so she is not required to pay that amount in order to end the RRP.

 

Example 3:

John is eligible for MAPP with a premium. He misses his January MAPP premium payment and an RRP is imposed for February, March, and April. In March, his employer decreases his work hours and John’s gross income is now under 100 percent of the FPL, making him eligible without a premium starting March 1. He pays the January and February premium arrears and regains MAPP eligibility effective January 1. If John did not pay the January and February premiums, he would open as of March 1.

RRPs are tied to non-payment of premiums only. RRPs do not apply to recipients who have not met HEC requirements.

26.6.2 Good Cause

The following are good cause reasons for not paying a MAPP premium:

1. Problems with electronic funds transfer.
2. Problems with an employer's wage withholding.
3. Administrative error in processing the premium.
4. Fair hearing decision.
5. Those you determine are beyond the member’s control.

This page last updated in Release Number: 20-03
Release Date: 08/03/2020
Effective Date: 08/01/2020

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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