|
|
Wisconsin Department of Health and Family Services Medicaid Eligibility Handbook |
|
|
Wisconsin Department of Health and Family Services Medicaid Eligibility Handbook |
2.1.4.7 Minors Living Independently
County/Tribal Social/Human Service agencies determine eligibility for all MA subprograms except:
Katie Beckett persons. (process by DHFS)
After care persons. (processed by Child Welfare agency)
Subsidized adoption persons (processed by Child Welfare agency)
SSI recipients ( processed by SSA and DHFS )
Make a decision on the client’s MA eligibility as promptly as possible. Do not delay making a decision on one program because eligibility has not been determined for another program of assistance.
Process on the Same Application
With the exceptions of the "Process Separately" subsection below, process everyone living in the same household on the same application.
Unless you have verified the relationship, assume that a male who is living in the home but not married to the mother of the minor applicant is not the minor's father. If the relationship isn't verified, answer all the questions in the handbook about him as if he isn't part of the assistance group.
Process Separately
Process the following persons in separate cases.
Institutionalized person
(5.8.4) But when both
members of a married couple are applying for community waivers (5.9),
put them on the same application.
Minor ward of unrelated legal guardians. This is because the unrelated guardian:
Is not financially responsible
for the minor, and
Cannot become eligible
along with the minor on this application.
If the legal guardian is related as an NLRR (3.5.3) follow the instructions in the paragraph "Mixed Family & NLRR Child".
All guardians , unrelated and related, must sign the application (IMM I-A-18.0.0).
18 year olds if applying
on his/her own. If the parents are applying for MA with the 18 year
old, process everyone on the same application.
Minors or 18 year olds
who are living in licensed foster or group homes, or in licensed child
care institutions. These cases are not processed in CARES. Process
these cases manually on a separate application.
Minor parents (and their
children) when all of the following conditions are true:
The minor parent (3.5.1.15)
has a child(ren) who is living in the household.
The other parent of the
minor parent's child(ren) is not living in the home; and,
The minor parent has been married.
Minor parent (and their child(ren) in common and the non-marital parent of the child(ren) in common where all of the following conditions are true:
The minor parent has
a child(ren) who is living in the household;
The other parent of the
minor parent's child(ren) is also living in the household; and
The minor parent and the other parent of the child in common are not married to each other.
The filing date is the day the signed application/registration
is delivered to the appropriate Income Maintenance agency or the next
business day if it is delivered after the agency's regularly scheduled
business hours.
The filing date on an ACCESS application is the date the application is
electronically submitted or the next business day if submitted after the
agency's regularly scheduled business hours.
When an application is received by mail or fax, date-stamp or write the date that you received the valid application form.
If less than a calendar month has passed since a client’s eligibility has been terminated and the client is not open for any other program, the client can provide the necessary information to reopen his/her MA without filing a new application.
If more than a calendar month has passed since a client’s eligibility was terminated and the client is not open for any other program, the client must file a new application to reopen his/her MA.
If less than 30 days has passed since the client’s eligibility was denied, allow the client to re-sign and date the application or page one of the CAF to set a new filing date.
If more than 30 days has passed since a client’s eligibility was denied and the client is not open for any other program, the client must file a new application to reopen his/her MA.
If the client is open for any other program of assistance, do not require him/her to re-sign his/her application or sign a new application.
Consider changes that occur between the filing date and CARES confirmation date in the application decision. Include changes which affect both eligibility and initial benefits, but do not hold or alter initial benefits after the CARES confirmation date.
For changes that occur after the processing date, follow the adequate and timely notice requirements IMM Chapter 1.2.2.
Process the application as soon as possible within 30 calendar days from the filing date and approve and/or deny (2.1.5.2, 2.1.5.3, 2.1.5.4) each subprogram of MA.
Extend the 30-day processing time up to an additional 10 days, if you are waiting for the client to provide additional information. CARES will issue a pending notice indicating the reason for the delay. To send a manual Negative Notice ( HCF 16001) complete the following steps explaining:
The reason for the delay. Use Item 8 in
the Negative Notice to explain the reason for the delay.
The information that must be provided to complete
the application.
The date by which this information must be provided.
Give the client at least 10 days to provide the requested information.
You may deny the application for failure to provide
information if:
Information requested was a mandatory verification
item (1.2),
and
The client had the power to produce the verification
within the period, but failed to do so, and
The client failed to provide the information within ten days and
the 10th day was the last day of the 30-day processing period or after.
|
Example 1: A signed page one of the CAF is received on March 15, 2002. The first day of the 30-day period is March 16, 2002. The end of the 30-day period would be April 14, 2002. Since April 14, 2002 is a Sunday, extend the last day of the processing timeframe to the next business day. This last day would be April 15, 2002. |
If the agency fails to take action (positive or negative) during the 30-day processing period, and the client is subsequently found eligible, restore any lost benefits using the original application date.
|
Example 2: A signed page one of the CAF is received on May 15th. The first day of the 30-day period is May 16th. The end of the 30-day period would be June 14th. The application is approved on June 20th, and the client is determined eligible. Certify MA for the client beginning May 1st. |
If an application is faxed into the IM Agency, the original application form is not required for processing. Do not deny MA because the original application form was not received.
If a worker identifies a need for additional information (i.e., self-employment income and expense details), that is not detailed on the application form, contact the client by telephone or mail to obtain self-declared information. Document any additional self-declared information that a client provides through a telephone or mail contact in case comments. If missing information is not provided timely, deny/terminate eligibility. If missing information is provided timely, determine if the self-declared information is questionable.
If mandatory verification is missing or an item is deemed questionable, send a written list ( EEVC ) of what needs to be provided and the due date for the information to be received. Allow the client until the end of the 30th processing day or 10 days from the request, whichever is later, to provide the requested information. If the information is not provided, deny eligibility for MA for failure to verify mandatory or questionable information or failure to provide/clarify necessary information.
Use the following two application forms to determine a client’s eligibility for MA only:
Information and Application for Wisconsin Medicaid
for the Elderly, Blind, and Disabled. (
HCF 10101 ).
Use this form when the client is elderly, blind, or disabled
and wishes to apply for MA only.
Information and Application for Wisconsin Family
Medicaid/BadgerCare (
HCF 10100 ).
Use this application form when the client wishes to apply for a subprogram of Family MA only.
If a client fills out any other application form than ( HCF 10101 ) or ( HCF 10100 ) and the application includes a request for another program of assistance, do one of the following:
Process the application as a mail-in application
for MA and schedule an interactive interview to complete the rest of the
application.
Have the client sign the Voluntarily Declining
Aid form ( DWSW 2233 ) for the other program of assistance and process
the application form as a mail-in application.
If the client indicates on ( HCF 10100 ) that a member of the family is blind or disabled, process the application and request any additional information from the client needed to determine EBD MA eligibility.
Complete client registration during the initial contact with the client or refer the client to ACCESS to complete and submit the registration. Mail the client page one of the CAF as well as the following items the same day the telephone application or review request is made:
Applying for Medicaid Fact Sheet (http://www.dhfs.state.wi.us/medicaid/index.htm).
Medicaid Eligibility and Benefits brochure ( PHC
10025 ).
Brochures and fact sheets specific to the client’s
circumstances (http://www.dhfs.state.wi.us/medicaid/ index.htm).
Do not complete the telephone interactive interview until the filing date (2.1.4.1) is set.
Schedule a time (within regular agency hours) that is convenient for the client for the telephone application. Inform the client that s/he needs to be available without interruptions for a specified time period to complete the application. The telephone interview can be scheduled before or after the filing date has been established.
Ensure that the client has had a reasonable opportunity to connect with you for the telephone interview before considering him/her a “no show.”
If at any time during the interview, the client wishes to apply for any other program, complete the MA application interview, determine MA eligibility, and schedule a face-to-face interview for the client at his/her earliest convenience.
Print out the Combined Application Form ( CAF ) from CARES and send it to the client. The client must initial and sign the CARES CAF on the signature page, and return it to the IM Agency. The client has until the end of the 30th day from the filing date or 10 days from the date the form is sent to him/her, whichever is later, to return the CARES CAF with any corrections indicated. If the form is not returned within this timeframe, deny the application for failure to sign the application form by overriding CARES eligibility with an 045 code on AGOE.
When the signed and completed application form is received timely, determine if the client made any changes to the information. If so, enter these changes into CARES. Determine eligibility and confirm the results using CARES. CARES will generate the appropriate approval or denial notice of decision.
If the signed and completed CARES CAF is returned after eligibility has been denied, treat the application as a new mail-in application. Contact the client for current information.
|
Example: A CARES CAF is sent to Mary on May 15th. Mary is expected to return it by May 30th. She does not return the CARES CAF signed by May 30th. Deny Mary’s MA eligibility and allow the appropriate notices to be sent out.
Mary sends in the signed CARES CAF on July 7th. Treat this as a new application, and use the date that it is received by the agency as the filing date. |
Process the application of a minor living independently the same way as you would process an application for an adult (IMM I, A, 12.0.0).
This page last updated in Release Number: 07-03
Release Date: 04/18/07
Effective Date: 04/18/07
|
|