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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/ |
The good faith effort policy provides more time for applicants and recipients making a good faith effort to supply the required documentation, but who are unable to do so during the reasonable opportunity period. This policy allows for the extension of the reasonable opportunity period without jeopardizing the original filing date or review date.
By "good faith effort" we mean the individual is taking steps to obtain the necessary documentation and has notified his/her worker of such efforts or has requested assistance from the worker to obtain the necessary documentation.
Utilizing the "good faith" policies for applicants and recipients does not impact an agency's timeliness performance that is reported to BEM. Any cases that have a verification extension are not considered untimely until the extension date is past due with no final action taken by the worker. It is possible to provide several back to back extensions without a timeliness penality as long as the worker takes action at the end of each extension period.
The application processing period can be extended to allow an applicant who is making a good faith effort to supply the required documentation. The IM worker must provide assistance to secure the necessary documentation if the applicant requests it. When the applicant provides the documentation, the IM worker must run eligibility from the original application filing date.
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Example 1: Mary applies for BC for herself and HealthyStart for her son on August 15, 2006. She has all of the necessary verification items for her son but does not have a copy of her Florida birth certificate. Her son’s HealthyStart eligibility can be confirmed. Mary’s worker enters the appropriate codes to pend BC eligibility for Mary. On September 5th, Mary informs her worker that she has contacted Florida and will receive a copy of her birth certificate in 3 to 4 weeks. Mary’s worker extends the verification due date another 4 weeks to allow Mary to comply with the new requirement. Mary presents her worker with her birth certificate on September 29th. The worker enters <BC> in the MA Citizenship verification field, runs SFEX and confirms Mary’s BC back to the original application date of August 15th.
Once an applicant supplies the documentation, certify his/her eligibility from the original filing date on the application. Under no circumstances, however, should applicants be certified as eligible for program benefits before the citizenship and identity documentation requirement is satisfied. |
Recipients making a good faith effort to secure the necessary documentation, but who are unable to do so during the reasonable opportunity period, may have their MA eligibility extended, even though the documentation requirement has not been satisfied. If the recipient requests it, the IM worker must provide assistance to secure the necessary documentation. MA eligibility may continue for as long as the recipient is deemed by the IM worker to be making a good faith effort to comply.
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Example 2: Ben completes his MA review on September 5th. The only item he was not able to verify was his citizenship. He was born in Washington but does not have a copy of his birth certificate. Ben calls his worker Tom on Sept 15th and tells him that his father who still lives in Washington, will mail him his birth certificate. Because Ben has been communicating with Tom, Tom enters <GF> in the MA Citizenship verification field with <GF> for Good Faith effort, runs SFEX and confirms the case. Tom then goes back and pends the MA eligibility by entering a <?> in the MA Citizenship verification field to allow Ben additional time to provide the necessary documentation. Ben presents the birth certificate to Tom on October 15th. Tom changes the <?> code to <BC>, runs SFEX and confirms Ben’s MA eligibility. |
This page last updated in Release Number: 07-07
Release Date: 08/30/07
Effective Date: 08/30/07