State of Wisconsin Department of Health Services

Release 24-03 December 18, 2024

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26.2 Application

26.2.1 MAPP Application Introduction

When someone who has a disability applies for health care (see Section 2.1 Applications Introduction), the request for health care is also a request for MAPPMedicaid Purchase Plan. 

Eligibility for MAPP will be determined if the member is not eligible for another form of full-benefit Medicaid.

26.2.2 Begin Month

MAPP eligibility can be backdated up to three months prior to the month of application (see Section 2.8.2 Backdated Eligibility). The memberA recipient of Medicaid; formerly referred to as a "client." may be certified for MAPP for any backdate month in which they would have been eligible for MAPP had they applied in that month. Before enrolling, the member is responsible for any premiums due (if owed) for the months in which they elect coverage, up to the current month (see Section 26.5.2 Initial Premiums).

MAPP applicants can also choose to begin their eligibility:

• The month of application
• The month after the month of application
• Two months after the month of application (if processed after adverse action)

Example 1:

Jack applies for MAPP on September 30 and requests backdated coverage for June, July, and August. His application is processed on October 21. He meets all eligibility requirements as of June. Jack can choose to begin MAPP eligibility in June, July, August, September, October, November, or December.

26.2.3 Fiscal Test Group

When both members of a married couple (living together) apply for MAPP, each person must be in a separate Assistance Group (AGassistance group). Enter them in CARES on the same application. The member’s spouseA spouse is that person recognized by Wisconsin law as another person's legal husband or wife. Wisconsin does not recognize common law marriage. is a countable member of the FTGfiscal test group. A separate financial test is done for each spouse’s AG. The married couple is entered on the same case, but they are in two separate AGs.

If a spouse of a MAPP applicantA person who has submitted a request for coverage for whom no decision has been made regarding eligibility chooses not to disclose or verify assets, a case may fail for a higher Medicaid eligibility and still cascade to MAPP eligibility.

If both members of a married couple (living apart) apply for MAPP, determine eligibility as two separate cases.

Include the member’s spouse and test children in the FTG. Test children include the member’s minorA minor is a person less than age 18. natural or adoptive children. Do not include the member’s stepchildren in the FTG. Do not count the income or assets of the test children.

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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