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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/ |
2.2.1.1.2 BadgerCare2.2.1.1.3 Family Planning Waiver (FPW)
2.2.1.1.3 Family Planning Waiver (FPW)
2.2.1.1.7 Backdating Wisconsin Well Woman MA (WWWMA) clients for Wisconsin Well Woman Program (WWWP)
Certify a person for MA with a begin date of the first day of the month in which s/he met all eligibility conditions.
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Example 1: A client reduces countable assets so they no longer exceed the asset limit. MA begins on the first of the month in which her assets met the asset requirement. |
Below are the exceptions to the first of the month policy. When all eligibility requirements are met, MA will not begin on a date earlier than:
Community Waivers - The program start date provided by the care manager.
Deductible - The date the deductible was met.
EBD – The disability onset date.
Family Care MA and Family Care non-MA- The Family Care enrollment date.
Inmates - The date the client is no longer an inmate of a public institution.
Institutionalized - His/her entry into the nursing home or hospital.
Newborn - The date the child was born.
Person Adds - The date the person moved into the household.
Pregnant Woman - The first of the month in which the pregnancy began. (5.2.6.1).The BCPP eligibility begin date is not the first of the month in which the pregnancy began, see 5.7.11.4 for BCPP eligibility begin date.
QMB - The first of the month following the eligibility determination (5.14.9.1).
Recent Moves - The date the client moved to Wisconsin.
Exception: The begin date for an SSI recipient who moves to Wisconsin is the 1st of the month of the move.
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Example 2: SSI recipient Mr. Nebble moves to Wisconsin from Vermont in April, 1999. He becomes eligible 04-01-99 in Wisconsin. |
SeniorCare – The first of the month following the month in which all eligibility requirements have been met (5.16.5).
Wisconsin Well Woman Medicaid - Certify the client for 12 months beginning with and including the certification month. Backdate to whichever is more recent:
Up to three months prior to the filing date.
To the day following the date of diagnosis.
If certifying for retroactive MA, do not go back further than the first of the month, three months prior to the application month. Certify the person for any backdate month in which s/he would have been eligible had s/he applied in that month.
A backdate request can be made at any time, except in the case where backdating the client’s eligibility results in a deductible for the backdated period.
If a client has incurred a bill from a MA certified provider during a backdate period, instruct the client to contact the provider to inform them to bill MA. The client may be eligible to receive a refund of a portion of the amount billed from the provider.
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Example: Al applied for MA on April 6th, and was found eligible for CARES Client Assistance for Re-employment & Economic Support category MS. At the time of application, Al did not request a backdate.
Al finds out in September that he had bills in February. Al can ask to have his eligibility backdated through February. Al meets all non-financial and financial eligibility criteria in the months of February and March. His worker certifies him for MS for both months. If Al had excess income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. for either February or March, he could not receive backdated coverage for February or March, because a six-month deductible period could not be established. |
A person’s asset eligibility in a backdate month is determined by whether or not s/he had excess assets on the last day of the month. If s/he had excess assets on the last day of the month, s/he is ineligible for the entire month. If s/he was asset eligible on the last day of the month, s/he is eligible for the whole month.
There is no backdating for BadgerCare.
There is no backdating for Family Planning Waiver (5.15.3).
Backdating for QMB only occurs for select circumstances. (5.14.09).
There is no backdating for SeniorCare (5.16.5.2).
Backdate a pregnant woman, applying for a program other than BCPP, to whichever is more recent:
The first of the month in which the pregnancy began.
The first of the month, three months prior to the month of application. If a woman was pregnant before the date of her application, backdate her MA, even though she is not pregnant on the date of application. Do not, however, give her an extension. Before backdating her MA, verify that she has met all the eligibility requirements during the retroactive period.
BCPP eligibility begin date is not the first of the month in which the pregnancy began, see 5.7.11.4 for BCPP eligibility begin date.
When manually certifying a woman for WWWMA through WWWP, manually certify her with one of the following starts dates.
The date of diagnosis (rather than the first of the month in which the diagnosis occurred), or
Up to 3 months prior to the WWWMA filing date, if the diagnosis date is more than three months in the past.
The recertification period should be set twelve months from the application filing date for WWWMA.
If the woman will turn 65 within the projected 12 month certification period, certify her though the end of the month in which she reaches 65 years of age.
When certifying a woman for WWWMA through FPW, manually certify any woman who has met the eligibility requirements for 12 months with one of the following starts dates.
The date of diagnosis ( rather than the first of the month in which the diagnosis occurred), or
Up to 3 months prior to the WWWMA filing date, if the diagnosis date is more than three months in the past, and the woman was eligible for FPW at the time.
The recertification period should be set twelve months from the application filing date for WWWMA.
This page last updated in Release Number : 07-01
Release Date: 01/12/07
Effective Date: 10/16/06
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