|
State of Wisconsin |
Release 24-02 |
Verify mandatory and questionable items at application, renewal, person addition or deletion, or when there is a change in circumstance that affects eligibility or benefit level. Do not reverify one time only verification items.
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. Applicants must be given at least 20 days to provide any necessary verification.
Eligibility must not be denied for failure to provide the required verification until the later of:
If you request verification more than 20 days prior to the 30th day you must still allow the applicant 30 days from the application filing date to provide the required verification.
Eligibility must not be denied for failure to provide the required verification until the 20th day after requesting verification or the end of the renewal month, whichever is later.
| Example 1: | Fred’s eligibility renewal is due in April. He submits a paper renewal form on April 8. The worker requests verification of his income on April 9. Because his renewal was returned by adverse action and verification requested, his health care is extended by one month. If the verification is not submitted by May adverse action, his eligibility will end on May 31. |
| Example 2: | Shannon's renewal was due in June. At adverse action in June, a notice was sent to Shannon to let her know her Medicaid eligibility would end June 30 because she did not complete her renewal. Shannon called the agency on June 30 and completed her renewal. Verification of income is requested with a July 20 due date. Shannon did not submit the required verification by July 20, so her eligibility beginning July 1 was denied. If Shannon submits the requested verification by September 30, it must be treated as a late renewal (see Section 3.1.6.1 Verification Requirements for Late Renewals) |
IM agencies must accept and process health care renewals and renewal-related verifications up to three calendar months after the renewal due date. Late renewals are only permitted for members whose eligibility has ended because of lack of renewal and not for other reasons. Members whose health care benefits are closed for more than three months because of lack of renewal must reapply.
This policy applies to the following programs:
The policy applies to members receiving health care benefits based on a met deductible, but not to members with an unmet deductible.
Late submission of an online or paper renewal form, or a late renewal request by phone or in person, is a valid request for health care. The new certification period should be set based on the receipt date of the signed renewal. If verifications are required during the completion of a late renewal, the member will have 20 days to provide it.
| Example 3: |
Jenny’s renewal is due on January 31, 2015. She submits an online renewal via ACCESS on March 15, 2015. If the renewal is processed on the same day and verification is requested, the verification will be due on March 25, 2015. If she provides verification on or before this due date and meets all other eligibility criteria, her eligibility and certification period will start on March 1, 2015. Her next renewal will be due February 28, 2016. The three-month period starts from the month the renewal was due. It does not restart when a late renewal has been submitted. |
| Example 4: |
Jenny’s renewal is due on January 31, 2015. She submits an online renewal via ACCESS on March 15, 2015. If the renewal is processed on the same day, and verification is requested, the verification will be due on March 25, 2015. If Jenny does not provide verification until May, she will need to reapply after the three-month period that started with her January renewal date. If a member has a gap in coverage because of his or her late renewal, he or she may request coverage of the past months in which the gap occurred and must provide all necessary information and verifications of income and assets for the current month and the gap months and must pay any required premiums to be covered for those months. Because QMB coverage is not retroactive, the ability to request coverage for past months does not apply for this program. |
| Example 5: | Jenny’s renewal is due on January 31, 2015. She completes her renewal on January 20, 2015, and a VCL is generated requesting income verification for the 30 days prior to January 20. Jenny does not submit the requested verification, and her BadgerCare Plus eligibility is terminated as of January 31, 2015. On April 27, 2015, she submits her paystubs for April 10 and April 24. If she meets the eligibility criteria for BadgerCare Plus, her certification period will start on April 1, 2015, and her next renewal will be due March 31, 2016. If she had submitted the verification of her income for January, a new VCL should be generated asking for verification of her current income for April. |
When a change is reported that requires verification, 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: 24-02
Release Date: 08/22/2024
Effective Date: 08/22/2024
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