State of Wisconsin Department of Health Services

HISTORY

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

22-01 Version of 26.4 MAPP Financial Requirements

Follow EBD rules in Chapters 15.1 Income Introduction and 16.1 Assets Introduction to determine countable assets and income. The following are MAPPMedicaid Purchase Plan financial eligibility requirements.

26.4.1 Assets

Total countable assets of the memberA recipient of Medicaid; formerly referred to as a "client." must be $15,000 or less. Only count the assets of the MAPP applicantA person who has submitted a request for coverage for whom no decision has been made regarding eligibility for the MAPP asset eligibility test.

26.4.1.1 Independence Accounts

Someone who has been determined eligible for MAPP can establish an Independence Account after MAPP eligibility has been confirmed. These accounts are an exempt asset. There is no limit to the number of accounts, and no restriction on what the money can be used for. The accounts are for the member to deposit earned and unearned income into. They cannot be used for the member to deposit other assets, such as an inheritance.

Only funds deposited in a registered Independence Account while the member is eligible for MAPP may be exempted from the asset limit. Any deposits made prior to MAPP enrollment or during periods of MAPP ineligibility are not exempt assets.

Note that there are different rules for retirement/pension accounts and non-retirement/pension accounts regarding how they may be registered as Independence Accounts and when funds may be deposited:

• Existing retirement/pension accounts may be registered as Independence Accounts after the applicant has been approved for MAPP. The amount that was already accumulated in the retirement/pension account before it was designated as an Independence Account is called the “Pre-Independence Account Balance.” The Pre-Independence Account Balance is considered a countable asset when MAPP eligibility is determined. Funds may be deposited in a retirement/pension account designated as an Independence Account during periods of MAPP ineligibility. However, any funds deposited during a period of MAPP ineligibility must be added to the account’s Pre-Independence Account Balance and considered a countable asset.
• Non-retirement/pension accounts may only be opened and registered as Independence Accounts after the applicant has been approved for MAPP. Non-retirement/pension accounts registered as Independence Accounts may only have funds deposited during months when the member is eligible for MAPP. If any funds are deposited in a non-retirement/pension account during a period of MAPP ineligibility, the Independence Account’s entire balance will be considered a countable asset.
  • For non-retirement/pension accounts registered as Independence Accounts on or after August 1, 2020, there should be no Pre-Independence Account Balance at any time because the only deposits that are allowed into these accounts are those made while the account owner is a MAPP member.
  • For non-retirement/pension accounts that were registered as Independence Accounts prior to August 1, 2020, any existing amount entered in the Pre-Independence Account Balance field will continue to count for all Medicaid programs, and the Independence Account Balance will be exempt for all Medicaid programs that have an asset test. However, no new funds may be deposited in non-retirement/pension accounts during months when the member is ineligible for MAPP. If new funds are deposited during months when the member is ineligible, the entire asset will be counted.

Example 1:

Sheila is approved for MAPP. She has an established retirement account through her employer that currently has a $5,000 balance. The $5,000 was considered a countable asset during her eligibility determination. Sheila registers the retirement account as an Independence Account with the IM agency. The money deposited into this retirement account while Sheila is a MAPP member will be considered an exempt asset as a part of an Independence Account. The $5,000 Pre-Independence Account Balance will continue to be a countable asset.

 

Example 2:

Mac is approved for MAPP in October. He fills out the Independence Account form to register his already established savings account as an Independence account. The IM worker will be unable to approve this account as an Independence Account because it was opened and established with funds deposited prior to Mac’s MAPP eligibility.

 

Example 3:

Tom is approved for MAPP. After he receives his Notice of Decision, he opens a savings account and registers it as an Independence Account. Tom is eligible for MAPP from July to October, eligible for Medically Needy SSI-related Medicaid from November to December, and eligible for MAPP again in January. Although his Independence Account will be considered exempt when his eligibility for both MAPP and Medically Needy SSI-related Medicaid is determined, he may not deposit any money into the account during November and December because he is not eligible for MAPP during that time. If he does deposit money during those months, the Independence Account’s entire balance will be considered a non-exempt asset.

 

Example 4:

Tom is approved for MAPP. After he receives his Notice of Decision, he registers his existing IRA as an Independence Account. This IRA has a balance of $1,000 prior to registration as an Independence Account, so that $1,000 is a countable asset. Tom is eligible for MAPP from July to October, eligible for Medically Needy SSI-related Medicaid from November and December, and eligible for MAPP again in January. Although the amount deposited into his Independence Account in July, August, September, October, and January will be considered exempt when determining his eligibility for both MAPP and Medically Needy SSI-related Medicaid, any money deposited into the IRA during November and December would be added to the $1,000 Pre-Independence Account Balance and counted as an asset because Tom was not eligible for MAPP during those two months.

To qualify as an Independence Account, an account must be:

1. Registered with the IMincome maintenance Agency. 
   1. Completing the F-10121 Medicaid Purchase Plan (MAPP) Independence Account Registration form registers the Independence Account with the IM agency.
   2. Scan the completed F-10121 to ECF and provide a copy to the member.
2. A separate financial account owned solely by the MAPP member.
3. Established after MAPP eligibility is confirmed, with the following exceptions:
   1. Pension and retirement accounts (see Section 26.4.1.3 Pension or Retirement Accounts)
   2. Non-retirement accounts that were registered as Independence Accounts before August 1, 2020 during a member's previous period of MAPP eligibility

Cash, escrow accounts for a home sale, money owed, prepaid debit cards, and tax refunds may not be designated as Independence Accounts.

A member’s deposits of earned or unearned income into an Independence Account may total no more than 50% of the member's gross earnings over the 12-month certification period. If the member’s deposits exceed 50% of their actual gross earnings over the same twelve-month period, a penalty is assessed (see Section 26.5.1.1 Independence Account Penalty). 

Amounts withdrawn from a MAPP Independence Account during the 12-month certification period do not affect the limit on the gross amount that may be deposited during the same period without penalty.

Example 5:

The agency is processing Fred’s MAPP renewal. During the previous 12-month certification period, Fred earned $5,000 from his job and received $12,000 in unearned income. During that same period, he deposited $3,000 into his Independence Account. At one point he withdrew $500 from his Independence Account to pay for car repairs.  The penalty is based solely on total deposits in excess of 50% of gross earnings over the twelve-month period. Withdrawals are irrelevant when determining the penalty. In this example, 50% of Fred’s $5,000 earned income = $2,500. The $3,000 in deposits - $2,500 = $500 penalty.

26.4.1.2 Independence Account Exemption Status

If a member with an approved Independence Account loses MAPP eligibility, the exempt portion of the account (on the date eligibility ends) will remain exempt for all future application(s) for all EBD Medicaid programs.

26.4.1.3 Pension or Retirement Accounts

A member who has a pension or retirement account can designate that account as an Independence Account. The initial balance is a countable asset (see Section 16.7.21 Retirement  Benefits). Any dividends, interest, and deposits to the account  while they are MAPP eligible are exempt from the date the Independence Account is approved. Continue to count the initial balance and any dividends, interest, and deposits to the account during periods of MAPP ineligibility as a countable asset.

26.4.2 Income

The spouseA spouse is that person recognized by Wisconsin law as another person's legal husband or wife. Wisconsin does not recognize common law marriage. and applicant or member’s net income must not exceed 250% of the FPLFederal Poverty Level (See 39.5 FPL) for appropriate fiscal test group size. To determine this, do the following:

1. Determine earned income. Count the member and his or her spouse’s income if residing together.
2. Deduct the $65 and ½ of the earned income disregardAn amount not counted when determining a person's total net income. from the spouse and member’s earnings (see Section 15.7.5 $65 and ½ Earned Income Deduction).
3. Deduct the member’s and spouse's IRWEs (see Section 15.7.4 Impairment Related Work Expenses (IRWE)).  The result is the adjusted earned income.
4. Determine unearned income. Count the applicant or member's unearned income and his or her spouse’s unearned income if residing together.
5. Add the adjusted earned and unearned income together.
6. Deduct $20 from the combined income.
7. Deduct special exempt income (see Section 15.7.2 Special Exempt Income).
8. Deduct all verified monthly out-of-pocket medical and remedial expenses incurred by a MAPP applicant or member (their spouse, if living together), if the monthly total of those expenses is above $500.
9. If a MAPP member receives Social Security payments, subtract the current COLAcost-of-living adjustment. An increase in income to compensate for inflation. disregard between January 1st and the date the FPL is effective in CARES for that year (see Section 15.3.35 COLA DISREGARD FOR SOCIAL SECURITY RECIPIENTS).
10. Subtract the historical COLA DisregardAn amount not counted when determining a person's total net income. Amount (see Section 39.6 COLA) for MAPP members who are also determined to be a 503 see (see Section 25.1 503 Eligibility) or Disabled Adult Child (DAC) (see Section 25.2 DAC).
11. Compare the result to 250% of the FPL (see Section 39.5 FPL Table). Include the member’s minor dependent children (natural or adoptive) when determining fiscal test group size. Include the member's dependent 18-year-oldAnyone age 18 is a dependent 18 year-old if he or she is classified as a full-time student in high school or in the equivalent level of vocational or technical training and reasonably expected to complete the program before age 19 or carrying sufficient credits to be reasonably expected to graduate or get a GED before reaching age 19. If he or she is, for example, carrying only 3 credits, but only needs 3 credits to graduate, he or she is a full-time student. child(ren) in the FTG. Do not include the member’s stepchildren in the fiscal test group size.

26.4.2.1 Deduction for Medical and Remedial Expenses over $500

For MAPP only, if an applicant or member (or his or her spouse, if living together) has verified monthly out-of-pocket medical and remedial expenses that total over $500, the total amount of these expenses will be deducted from the applicant or member’s and his or her spouse’s income when determining whether that income is above 250% FPL in the calculation shown in 26.4.2 Income.

Example 7:

Shelly applies for MAPP. She verifies $350 in out-of-pocket remedial expenses for herself and $200 in out-of-pocket medical expenses for her spouse that cannot be covered by MAPP or any other third party. $550 will be deducted from income as a part of Shelly’s eligibility determination.

 

Example 8:

Mary applies for MAPP. She verifies $600 in monthly out-of-pocket medical and remedial expenses, which brings her under the 250 percent of FPL income limit for MAPP. It is possible that these expenses might be covered by MAPP once Mary is eligible, but the IM worker correctly processes the application using these verified out-of-pocket expenses. One month later, Mary realizes that MAPP is now paying for $500 of these medical and remedial expenses. Mary is required to report this change in expense within 10 days. She reports that her medical expenses have dropped to $100. The IM worker enters this change, and Mary is no longer financially eligible for MAPP because the decrease in her out-of-pocket medical and remedial expenses increases her countable income. If Mary applied again using the same expenses, the IM agency would not allow the expenses because they are now known to be covered by Medicaid.

 

Example 9:

Jim applies for MAPP. He verifies $500 in out-of-pocket medical expenses. Because the expenses are not above $500, these expenses cannot be allowed as an income deduction for the MAPP eligibility determination.

 

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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