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State of Wisconsin |
Release 26-02 |
Proof of certain information is required to determine eligibility for Medicaid. Mandatory (see Section 20.3 Mandatory Verification Items) and questionable (see Section 20.4 Questionable Items) items must be verified at application, renewal, person addition or deletion, or when there is a change in circumstance that affects eligibility or benefit level. One-time only verification items do not need to be re-verified. For changes in circumstance and timely renewals, current benefits are maintained until a redetermination of benefits is completed.
Verification means to establish the accuracy of verbal or written statements made by, or about an individual's circumstances. Case files or case comments must include documentation for any information required to be verified to determine eligibility or benefit levels.
Exception: Veterans benefits, including allowances for Aid and Attendance, Housebound, and Unusual Medical Expenses usually increase only once a year, in January. If an IM agency verifies the January veterans benefit increase, it does not have to re-verify the veteran benefit income at the time of the next scheduled eligibility renewal, which occurs later in that same year. If another change in the veterans benefit does occur between January and the next scheduled eligibility renewal, that income change will have to be verified. This exception is being adopted to reduce the verification workload for both the IM agency and Veterans Administration staff, who routinely pursue and provide veterans benefit income verification every January.
The time period for processing an application for Medicaid is 30 days from the filing date (see SECTION 2.6 FILING DATE and SECTION 2.7 APPLICATION PROCESSING PERIOD).
Eligibility cannot be denied for failure to provide the required verification until the later of:
The applicant will be advised of the specific verification required and given a minimum of 20 calendar days to provide any necessary verification.
Eligibility must not be denied for failure to provide the required verification until the 20th day after requesting verification. Renewal verifications are accepted late if they are received anytime within the three months following the renewal month. The three-month period begins the month after eligibility ends. If verifications are required to complete a timely or late renewal, the member will have 20 days to provide it.
When a member reports a change that requires verification, current health care benefits are maintained while the change is being processed, including while verification is requested. The member must be notified in writing of the specific verification required and allowed a minimum of 20 days to provide it.
Wisconsin Medicaid uses data exchanges with the Wisconsin Vital Records Office and the Social Security Administration (SSA) to identify when an applicant or member has died and to verify the date of death.
When date of death (DOD) information received from Vital Records exactly matches an applicant or member’s SSN and other demographic information, it is considered verified, and a notice of decision is sent to the household. No refutation period is required.
When DOD information received from Vital Records matches an applicant or member’s SSN but does not exactly match other demographic information, another source, such as a family member or another data exchange, must be used before the DOD can be considered verified.
When an SSA data exchange indicates that an applicant or member has died and the IM agency has not received any other information to confirm the death, the member, another family member, or the member’s representative must be allowed 10 days to correct any misinformation prior to benefits being impacted. For ongoing cases, the member for whom a death match was received will still be considered to be alive and benefits for the member or others on the case will not be changed or pended during this time. The case should be pended when verifications, such as earned income, are needed. Benefit changes due to changes in eligibility will still need to be processed. However, for an application, person add, or renewal, it means allowing at least the minimum 10 days for a response before a worker confirms eligibility for the application, renewal, or person/program add.
This 10-day period is known as the “refutation period.” A letter is automatically sent to the primary person requesting a response if the individual is not deceased. The response due date must be extended to a longer period to allow for mailing delays due to weekends or holidays (will follow the VCL due date logic). The refutation period may only be shortened when either:
At the end of the refutation period, if no response is received from the member or applicant or the household, the date of death is considered verified and eligibility for the household must be redetermined and a notice of decision issued.
This page last updated in Release Number: 25-04
Release Date: 12/10/2025
Effective Date: 12/10/2025
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