State of Wisconsin Department of Health Services

Release 24-02 August 22, 2024

View History

26.7 MAPP Changes

26.7.1 MAPP Changes Introduction

The memberA recipient of Medicaid; formerly referred to as a "client." must report within ten days all changes to income, household composition, allowable deductions, including medical and remedial expenses that were once out of pocket but are covered once the applicant is a MAPP member, and other non-financial changes, including loss of employment, which affect eligibility. The IMincome maintenance worker should re-determine eligibility as a result of the changes. If it is determined that he or she remains eligible for MAPPMedicaid Purchase Plan and owes a premium, recalculate the premium amount.

Example 1:

Nancy does not have health insurance and currently pays $550 a month for a variety of medical/remedial expenses. She applies for MAPP and is found eligible as of December 1. Once she is eligible, MAPP will cover some of her medical/remedial expenses and reduce her out of pocket medical/remedial expenses down to $50 a month in December. Because Nancy must wait until the end of December to determine the final decrease in her monthly out of pocket expenses, she must report this decrease no later than January 10th.

26.7.2 Reduced Premiums or No Premiums

The effective date of a change that results in a reduced premium or no premium is the month of change or the month of report, whichever is later.  If the change results in no premium, the IM agency may have to run eligibility with dates in CARES for the month the change occurred or was reported (whichever is later) and any subsequent months as well as for recurring.

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