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Wisconsin Department of Health and Family Services |
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Wisconsin Department of Health and Family Services |
Give an Information for Medicaid - Disability Applicants form ( HCF 10112 ) to each person applying for MA Disability.
Give each applicant a Medicaid-Disability Application form
Make sure the form is filled out completely with names and addresses of all medical sources that have treated the applicant.
Applicants must list all of their medical problems.
An applicants' employment background is important in determining disability in most cases. The more information you can provide the better. DDB must have a 15-year work history. Detailed information about current work is necessary in all cases.
DDB may consider a medical onset of disability date going back to the first of the month, three months prior to the date of the signed application.
Ask the applicant to sign a Confidential Information Release Authorization – Release to Disability Determination Bureau form (HCF 14014) for each medical source identified on the application form plus several additional copies. (Some hospitals and institutions require a release for each department.) This is the only form DDB can accept.
Leave the box blank that asks for the “Name and Address – Agency/Organization Authorized to Release Information.” DDB has scanners that will automatically fill in the blank. Filling it in creates problems for them.
Applications for disability made by the applicant must include releases that are signed personally by the disabled applicant. Applications made on behalf of a disabled applicant must be accompanied by release forms signed by a legally appointed representative. A copy of the court order appointing a representative must be included with the application. An authorized representative’s signature on the release is not acceptable unless s/he has a court order.
A medical report of disability does not need to be submitted with the application. DDB will obtain all of the medical reports necessary for the disability determination.
If the applicant has copies of any medical records, school records, etc., include them with the application. See 3.6.1 for the DDB address.
Applications that are not fully completed with names and addresses and work information will be returned to the local ESA.
Occasionally a person applies for SSI and is determined ineligible for SSI payments. In these cases, determine MA eligibility from the SSI application date, if it is earlier than the ES application date.
An application for SSI is also an application for MA.
S/he must still meet all MA eligibility requirements. You must request the SSI application date by using the state on line query ( SOLQ ).
Use the SSI application date as the filing date if the client contacts the ESA within the calendar month following the month of the SSI denial. If the contact to the ESA is later than the above, the filing date is the regular date s/he applied at the ESA.
The ESA fills the gap in eligibility between the loss of SSI-MA and an eligibility determination by the ESA. Certify the client for the period between the loss of SSI-MA eligibility that appears on MMIS and when you will be able to determine their MA eligibility. Determining MA eligibility should usually occur within the month after s/he loses SSI.
When a person applies for SSI and is denied, there is no obligation to “fill gaps.” The exception to this is in 3.6.2.5.
The ES agency will fill the gap in eligibility when an ongoing SSI case is terminated. The person is eligible for a re-determination of MA eligibility by the ESA. S/he should apply within the calendar month of notification of termination. An extra month of SSI-MA eligibility is posted on MMIS to allow the client time to have eligibility determined by the ESA.
There is no fill the gap provision for those who lose their SSI eligibility
because of:
Death
Leaving Wisconsin
Incarceration
Fleeing drug felon
The processes differ based on if the client is already open for another program in CARES Client Assistance for Re-employment & Economic Support or if they aren’t open in CARES. The starting point for both CARES and non-CARES cases is an MMIS and SOLQ query.
Active CARES cases- An active case in CARES is one in which the person is part of a case where at least one person is currently open, or closed less than 30 days for at least one program of assistance. If the client has an active case in CARES, EDS sends a list to the agency’s CARES coordinator of those losing SSI and sends those clients a letter saying the ES worker will contact them if there isn’t enough information to determine eligibility.
As soon as the ES worker receives the list of those in active CARES cases, s/he:
Opens the client for MA in CARES. This
may seem unusual since s/he will show eligibility on MMIS for a grace
month. The
reason you open all of them in CARES is to provide a tracking mechanism
to show you “filled the gap” and that the client receives the correct
notice, if s/he fails eligibility later. CARES
instructions are:
ACPA- Request MA
ANBR- Change the Y in the SSI field to N or on ANBC – change the Y in the 1619(b) field to N.
Don’t change any financial information (unless you need to in order to make the person eligible).
Complete any other required demographic information.
Verifications aren’t required at this point.
Run eligibility and confirm.
The day after you open the case, request verification of any items you need to determine continued MA eligibility. At this point, treat the case as a regular case, and all verification rules, etc. apply. The client has 10 days to provide verifications.
Non CARES-
If the client doesn’t have an active case on CARES, EDS sends a letter
along with an application telling him/her that s/he must apply. The
client sends the application to EDS and EDS forwards it to the CARES coordinator,
who assigns it to a worker. The
worker enters the case and determines eligibility. MMIS
will close those cases that do not send an application within 30 days
of their request.
Reminder: For all cases, (CARES and Non-CARES) even if the client doesn’t meet MA eligibility requirements for the months between when s/he lost SSI and when you are re-determining eligibility, s/he is still eligible. Don’t require the client to come into the office. Ineligibility starts, following timely notice, when s/he:
Does not return the application ( EDS takes care of this, or
Fails to respond to an information request, or
No longer meets eligibility requirements (only forward from when the review or application is done).
Fill the gap between the loss of SSI-MA and an eligibility determination by the ESA when:
Retroactive SSI approval and termination occurs.
A
person applies for SSI and is approved. The
approval is retroactive and the SSI also is terminated retroactively.
Eligibility for MA is not determined timely by the ESA through no fault of the client.
This page last updated in Release Number : 03-01
Release Date:01/01/03
Effective Date: 01/01/03
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