State of Wisconsin Department of Health Services

Release 24-02 August 22, 2024

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36.3 WWWMA Nonfinancial Requirements

36.3.1 Introduction

The following are WWWMAWisconsin Well Woman Medicaid specific non-financial requirements:

1. Live in Wisconsin,
2. Meet general EBD citizenship and ID requirements.
3. Be under age 65.
4. Have been screened for breast or cervical cancer by the Well Woman Program, or enrolled in Family Planning Only Services.
5. Be diagnosed for breast or cervical cancer, or certain pre-cancerous conditions of the cervix, as identified by the clinical screener.
6. Require treatment for the breast or cervical cancer, or pre-cancerous conditions of the cervix, as identified by the clinical screener.
7. Not be eligible for BadgerCare Plus or EBD Medicaid.
8. Meet the insurance coverage requirements listed below in 36.3.2 Disqualifying Insurance Coverage

36.3.2 Disqualifying Insurance Coverage

A person is ineligible for WWWMA if they are currently covered by any one of the following:

• Group health plans that cover treatment for their breast or cervical cancer or precancerous condition of the breast or cervix
• Full benefit health insurance that covers treatment for their breast or cervical cancer or precancerous condition of the breast or cervix
• Medicare Part A
• Medicare Part B
• BadgerCare Plus without a premium or any other category of full benefit Medicaid that covers their treatment for breast or cervical cancer or precancerous condition of the breast or cervix

  Note:

  An unmet deductible is not full-benefit Medicaid.

• Veteran's benefits/TRICARE that cover treatment for their breast or cervical cancer or precancerous condition of the breast or cervix
• Federal employee health plans
• Peace Corps health plans
• Other full-benefit private or public health care plans that provide cancer treatment as determined by their health care team

36.3.3 Non-Disqualifying Insurance Coverage

1. The following health care benefits do not disqualify an applicantA person who has submitted a request for coverage for whom no decision has been made regarding eligibility or member from WWWMA:
   1. Coverage only for accident or disabilityThe law defines disability for Medicaid as "The inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." income insurance, or any combination thereof,
   2.  Liability insurance including general liability insurance and automobile liability insurance,
   3. Workers’ compensation or similar insurance, credit-only insurance,
   4. Coverage for on-site medical clinics,
   5. Other similar insurance coverage, under which benefits for medical care are secondary or incidental to other insurance benefits,
   6. Indian Health Services,
   7. Non-coverage of cancer treatment due to waiting period, or
   8. Non-coverage of breast or cervical cancer treatment due to exclusion (max out) of cancer treatment in the policy.
2. Separate health insurance benefits that are not considered health insurance if offered separately are:
   1. Limited scope dental or vision benefits, or
   2. Benefits for long-term care, nursing home care, home health care, community-based care or any combination thereof.
3. Independent uncoordinated benefits are not considered health care insurance if offered as independent and/or uncoordinated benefits (for example, coverage only for specified disease or illness, hospital indemnity or other fixed indemnity insurance).
4. Separate insurance policies are not considered health insurance if offered as a separate insurance (Wrap Around) policy:
   1. Coverage supplemental to military insurance (ex., TRICARE wrap around), or
   2. Similar "wrap around" supplemental coverage under a group health plan.  
5. Creditable coverage plans that do not cover treatment for the breast or cervical cancer due to a waiting period, exclusion or carve out restrictions.

Note:

Current coverage under Medicare Parts A or B will disqualify an applicant or member from WWWMA eligibility.

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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