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Wisconsin Department of Health and Family Services Medicaid Eligibility Handbook |
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Wisconsin Department of Health and Family Services Medicaid Eligibility Handbook |
MA applicants who are infected with tuberculosis ( TB ) are non-financially eligible for TB-related MA services.
Consider these persons to be in a special category of MA. They are non-financially eligible for TB-related MA if they are infected with TB, even if they are not blind, disabled, or over age 65. “Infected with TB” means that a physician has examined them and found that one or more of the following diagnoses apply to them:
Infected with latent or active TB.
Positive TB skin test.
Negative TB skin test, but a positive sputum culture
for the TB organism.
Negative test for TB, but a physician certifies
that they require TB-related drug therapy or surgical therapy or both.
A physician certifies that they require testing to confirm the presence or absence of TB.
Accept the client’s statement that they have one or more of the above conditions unless the information provided is questionable (1.2.4). If questionable, accept any of the following as verification:
A physician's or registered nurse's written confirmation
that the person has one or more of the above conditions.
Wisconsin Tuberculosis Record ( Form DPH 4756 ). This card identifies the person and the physician's diagnosis, and has on it the name and telephone number of the treatment provider.
Assets. The asset limit for one person is $2,000. Count assets the same as for other EBD AGs.
Income .. The income limit for one person is $1,213. This is gross income. There is no net income test.
Deductible. TB-related AGs which fail the TB-related gross income test cannot become eligible for a MA deductible.
If more than one person in the AG is TB-infected, test each person as a single individual with his/her own fiscal test group. Do not deem assets or income from any other member of the AG.
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Example 1: Mary and her spouse George are both applying for TB-related MA. Test Mary and George as separate fiscal test groups. Do not deem assets or income from Mary to George or from George to Mary. Test Mary's assets against the asset limit. Test her income against the income limit for one person. Test George's assets against the asset limit. Test his income against the income limit for one person. |
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Example 2: There are three children in the Kraan family. All of the children have TB. Consider each child to be a separate fiscal test group. Test each child using only his/her own assets and income. Each child’s assets do not exceed the asset limit (5.11.7.2). Each child’s income limit does not exceed the income limit (5.11.7.2). Do not deem assets or income from the child’s parents or from any of his/her siblings. |
If only one person in the AG is TB-infected, and that person
is a:
TB-infected minor or 18-year-old.
Test him/her in the Financial Tests for Disabled Minors (1.1.3.1.2). Add the parents' deemed assets and income to the minor or 18- year-old's assets and income. Test him/her against the asset limit and the gross income limit.
TB-infected adult with assets/income, and spouse with no assets/income.
Test the TB-infected adult's assets/income against the asset limit and the gross income limit.
TB-infected adult with assets/income, and spouse with assets/income.
Use the EBD-Related Determination Worksheet (WKST 06) to determine the spouse's assets and net income. Add these totals to the TB-infected person's assets and gross income. Compare this total to the asset limit and the gross income limit.
TB-infected adult with no assets/income, and spouse with assets/income.
Use the WKST 06 to determine the spouse's assets and net income. Compare these results to the asset limit and the gross income limit.
When using the WKST 06, disregard items 16-18. Replace item 19 with the TB-related income limit. Disregard item 20.
Persons who become eligible for TB-related MA receive an MA card that identifies them as eligible for only the following MA services:
Prescribed drugs.
Physicians' services.
Laboratory and X-ray services, including services
to diagnose and confirm the presence of infection.
Clinic services and federally qualified health
care ( FQHC ) services.
Targeted case management services.
Services, other than room and board, designed
to encourage completion of regimens of prescribed drugs by outpatients.
Services that are necessary as a result of the side effects of prescribed drugs for TB treatment.
QMB, SLMB, and QDWI recipients do not automatically qualify for TB-related MA services. If they are eligible for EBD or Family MA, they can receive TB-related services under regular MA.
TB-related services are included among emergency services for persons who do not meet citizenship requirements (3.2.2).
Determine TB-related AGs manually in the following way:
Determine MA eligibility for all other subprograms in CARES. Do not confirm unless there is eligibility for a category of MA that is not QMB, SLMB, or QDWI.
If there is only QMB, SLMB, or QDWI eligibility, test the person against the TB-related financial tests. Complete and return a HCF 10110 (formerly DES 3070) to EDS:
Mail: EDS
P.O. Box 7636
Madison, WI 53707
E-mail: eds_3070@dhfs.state.wi.us
Fax: (608) 221-8815
If the client is eligible, certify him/her with
a manual HCF 10110 (formerly DES 3070) form, medical status code of TR.
Confirm all denials in CARES and allow the CARES generated notices
to be sent. Send him/her a manual positive notice with the effective
date of his/her eligibility for TB-related services.
If the person is not eligible for any MA subprograms, including TB-related MA, confirm all denials in CARES and allow the CARES generated notices to be sent. Send him/her a manual negative notice indicating that s/he is not eligible for TB-related MA.
This page last updated in Release Number : 04-03
Release Date: 08/02/04
Effective Date: 08/02/04