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Wisconsin Department of Health and Family Services Obsolete Medicaid Eligibility Handbook For the current MEH, see http://www.emhandbooks.wi.gov/meh-ebd/ For the current BC Plus Handbook, see http://www.emhandbooks.wi.gov/bcplus/ |
1.2.3.1 Social Security Number
1.2.3.7 Power of Attorney and Guardianship
Verify the following mandatory items:
SSN (1.2.3.1).
Alien Status (3.2.2.).
Pregnancy, if eligibility is based on the pregnancy (5.2.1).
Disability and Incapacitation ( 3.6.1).
Assets, for the Elderly, Blind and Disabled (EBD) (4.5.1).
Divestment, for EBD (4.7.1).
Medical Expenses, for deductibles only (4.9.8).
Documentation for Power of Attorney and Guardianship (1.2.3.7)
Migrant workers eligibility in another state (5.11.8.1), if applicable.
Physician certification (verbally or in writing) that the person is likely to return to the home or apartment with-in 6 months for institutionalized persons maintaining a home or property (4.1.3.1) and is entitled to a home maintenance allowance.
Earnings/health insurance for BadgerCare (5.7.3.6).
Accept self declaration for all other items, unless you document them as questionable.
Social Security Numbers ( SSNs ) need to be furnished for household members requesting MA, but are not required from non-applicants.
SSNs should be recorded in CARES Client Assistance for Re-employment & Economic Support if obtained voluntarily from the client, or if the information is available through other information sources (e.g. bank statement).
An applicant does not need to provide a document or social security card. S/he only needs to provide a number, which is verified through the CARES SSN validation process.
If the SSN validation process returns a mismatch record, then the client must provide the social security card or another official government document with the SSN displayed. If an applicant does not yet have a SSN s/he must be willing to apply for one.
Inform the client if the SSN validation process suggests that another individual is using the same SSN. Advise the client to contact the Social Security Administration. The client may request Social Security Administration to conduct an investigation. Do not provide the client with any information that would identify the individual who is using the client's SSN.
If the Social Security Administration finds that the SSN has been used fraudulently it may:
Recommend further action be taken.
and/or
Provide the client with the information on the fraudulent action so that the client may pursue action through the legal system.
Verify the SSN only once.
Assist the client in applying for an SSN for any group member who doesn’t have one (IMM, Ch. I, Part C).
Do not deny benefits pending issuance of a SSN if you have any documentation that an SSN application was made. A parent of a newborn may begin a SSN application on the newborn’s behalf while still in the hospital. Verify this through the Birth Record Query.
Do not require an SSN to be furnished or applied for on behalf of a newborn determined continuously eligible (5.2.5) for MA. Accept the mother’s statement about the existence and residence of the newborn.
The Medicaid fiscal agent, EDS, receives notification of children born to Medicaid recipients from hospitals and HMOs. EDS certifies these newborns as Continuously Eligible Newborns in the Medicaid Management Information System and sends a letter to both the mother of the newborn and to the certifying agency. This newborn letter received from the fiscal agent is a reported change. For purposes of Medicaid, the worker should add the newborn to CARES entering the pseudo SSN based upon the letter received on the CARES screen ANID. No further proof is required.
Do not require or verify SSNs of clients who receive emergency services only. (3.2.3)
Women applying for the BCPP do not need to apply for or provide an SSN.
A client who indicates s/he is not a citizen must provide an official government document that lists his/her alien registration number. Verify the individual’s alien status by using the Systematic Alien Verification for Entitlement ( SAVE ) system. Women applying for BCPP (5.7.11) and persons applying for EMA (3.2.3) who do not provide proof of alien/immigration status can still qualify for those benefits.
An alien that presents documentation of his/her alien status and meets all other eligibility criteria is presumptively eligible. Begin benefits and determine, through SAVE, that s/he is in a satisfactory immigration status.
Verification of alien status is not needed if the person already provided proof when s/he applied for an SSN.
Do not re-verify alien status unless the client reports a change in citizenship or alien status.
If a woman wants to be considered pregnant for a MA eligibility determination or BCPP (5.7.11), documentation from a health care professional attesting to the pregnancy is required. Fetus count and the pregnancy end date are not mandatory verification items.
Verification sources are:
Physician's statement
Physician assistant's statement.
Licensed nurse practitioner's statement.
A written statement from a registered nurse (RN) working in a:
Healthy Birth Identification of Pregnancy Project (EDP).
Publicly funded family planning project
Certified Nurse Midwives
A valid Presumptive MA eligibility card.
For any person who wants to be considered disabled for MA, including the Medicaid Purchase Plan ( MAPP The Medicaid Purchase Plan (MAPP) offers people with disabilities who are working or interested in working the opportunity to obtain health care coverage through the Wisconsin Medicaid Program. ), DDB must complete a disability determination (3.6.1). There is no need to re-verify after the initial determination. Disability reviews are scheduled by DDB and they will send any new information to you. Receipt of SSI or OASDI benefits benefits is verification of disability.
Verification of assets is mandatory for clients requesting the following MA subprograms:
EBD (categorically and medically needy).
EBD Special Status ( 503, Disabled Adult Child, Widow/widowers ).
Medicaid Purchase Plan ( MAPP ).
Institutional MA.
Community Waivers, including PACE and Partnership.
Family Care.
Medicare Premium Assistance Programs.
Also verify assets of community spouses for community waivers, institutional MA and Family Care non-MA. If reported assets exceed the asset limit, do not pursue verification.
Do not verify exempt assets.
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Example: An EBD MA client’s burial plot is not counted in determining his/her MA eligibility. Do not require verification of its value in determining the group’s MA eligibility.
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You do not need to verify cash on hand.
See IMM, Chapter 1, Part C for asset verification sources.
Verify if a client or spouse has divested assets when determining eligibility for institutional MA and community waivers (4.7.1).
Verify medical expenses if they are used to meet a deductible. Verify the expense and date of service.
Verify power of attorney and any guardianship type as specified by the court. Ask for any documentation regarding durable power of attorney or court-ordered guardianship. For applications and other relevant applicant information, refer to Power of Attorney as “Power of Attorney for Finances”.
The IM Agencymust determine the guardianship type specified by the court. Only the person designated as “guardian of the estate,” “guardian of the person and estate,” or “guardian in general” may attest to the accuracy of the information on the application form and sign it. Do not require a “conservator” or “guardian of the person” to sign the application form.
This page last updated in Release Number: 07-03
Release Date: 04/18/07
Effective Date: 04/18/07