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Wisconsin Department of Health and Family Services |
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Wisconsin Department of Health and Family Services |
Send Reconsideration/Hearing requests to:
Disability Determination Bureau
Medicaid Reconsideration Unit
P.O. Box 7886
Madison, WI 53707-7886.
Requests for Reconsideration/Hearing must be received by DDB within 45 days of the date of the Denial Notice. Late requests cannot be honored. DDB will notify the client that his/her request for a reconsideration/hearing has been denied if the client's request was not received by DDB within the 45 day deadline.
DDB will conduct a reconsideration of the denial. If DDB reverses the decision to an allowance, the determination and folder will be sent to the IM Agency.
If DDB affirms the denial, a Reconsideration Denial notice will be sent to the applicant (a copy will be sent to the IM Agency) and the file will be sent directly to the Division of Hearings and Appeals, which will then schedule a hearing.
If, in a fair hearing, a person is found to be disabled, and the hearing officer does not specify a date for review, contact DDB and request a date to review the disability.
When DDB notifies the IM agency that a disability denial decision has been reversed (approved) as a result of a Reconsideration/Hearing request, the IM agency must redetermine the individual’s Medicaid eligibility.
Use the original Medicaid
application filing date that was associated with the MADA
decision that has now been reversed (approved).
Re-evaluate the client’s
Medicaid eligibility for all months between the Medicaid application filing
date (and 3 month backdate period if appropriate) and the date of the
DDB approval.
For this
retroactive period, certify the client only for those months for which
they met all Medicaid eligibility requirements.
Send the client a positive
notice, advising them of the months of retroactive eligibility, and current
ongoing eligibility if appropriate. If
the client was ineligible for Medicaid for some of the prior months, send
the client a negative notice, advising them of his/her retroactive ineligibility
for those specific months.
For these types of cases, the IM worker is simply doing what ordinarily would have been done if the original DDB decision had been approved, rather than denied.
3.6.4.1.1 CARES Processing
Based upon the assumption that the Medicaid CARES case has been closed for more than 30 days since the original denial decision date, you will now have to enter a new application in CARES using the application function. Do not require the client to file a new application. Use the recent DDB disability approval date as your Medicaid application filing date. You should now be able to use CARES to determine and certify the current month’s Medicaid eligibility and up to 3 backdate months. If you need to go back any further than this, do the eligibility determination and certification manually.
This page last updated in Release Number: 07-05
Release Date: 07/10/07
Effective Date: 07/10/07
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