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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/ |
To calculate the dollar amount of the MA deductible for a regular MA fiscal test group:
Determine the MA deductible period (4.9.3) for this fiscal test group.
Find the fiscal test group's total net 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 each month in the deductible period.
For the months after the month of application, use prospective net income. (Income that may have been disregarded in the eligibility test which must now be counted, add back in, when determining the deductible period ) (5.11.4).
Compare the total net income of each month with the group's medically needy income limit. If the group is an:
If a month's income is less than or equal to the medically needy limit, ignore it.
If a month's income is more than the medically needy limit, find the excess income by subtracting the income limit from the net in-come of that month.
Add together the excess income of the months in the deductible period. The result is the MA deductible.
To calculate the MA deductible for non-Healthy Start persons who were tested individually and who failed the FFU Income Test:
Find all the members of this person's FFU. If you do not know how to determine who is in this person's FFU, consult 4.8.
From the members of this FFU form a group that includes all Family MA related persons who are eligible or would be eligible except for excess income. But do not include any:
Pregnant Women.
Children under age 6.
Caretakers (3.5.2) who failed the individual categorically needy income test.
Determine the MA deductible period (4.9.3) for this person.
Find the monthly excess income of each of the persons in the group you formed in #2. Do this by subtracting each person's individual medically needy income limit from his/her income test amount (FFU Income Worksheet).
Add the monthly excess incomes of these persons together.
The total is this person's MA deductible.
To calculate the MA deductible for Healthy Start persons who were tested individually and who failed the FFU income test for Healthy Start:
Find all the members of this person's FFU. If you do not know how to determine who is in this person's FFU, consult 4.8
From the members of this FFU form a group that includes all Family MA related persons who are eligible or would be eligible except for excess income. But do not include any:
Children age 6 or over.
Non-pregnant caretakers.
Stepparents.
Nonmarital co-parents.
Determine the MA deductible period (4.9.3) for this person.
Find the monthly excess income of each of the persons in the group you formed in #2. Do this by subtracting each person's individual medically needy income limit (8.1.6) from his/her income test amount ( FFU Income Worksheet ).
Add the monthly excess incomes of these persons together.
The total is this person's MA deductible.
Institutionalized and non-institutionalized persons can be eligible back to the 1st of the month, 3 months prior to the month of application. Even if they are ineligible in the month of application, they may still be eligible for retroactive coverage. When an institutionalized person requests retroactive MA, test him/her against the nonfinancial and financial standards that are appropriate to the month being tested. For the months s/he was not institutionalized, use the EBD asset and income limits (8.1.5). For the months s/he was institutionalized, use the institutional eligibility criteria found in 5.8.
For the months in which s/he was not institutionalized, s/he may be eligible in some, but ineligible in others, due to excess income. In this situation, s/he has 2 choices:
To be certified for the months s/he is eligible, and accept the ineligibility of the other months in which s/he has excess income, or
To meet a deductible. The deductible period begins in the backdate month that s/he chooses, and extends 6 months. Calculate the deductible for the full 6-month deductible period. Calculate the deductible by comparing his/her monthly income for each of the 6 months to the EBD medically needy income limit, not the institutional income limit.
Expenses which can be counted against the deductible
are those listed in 4.9.8.1 plus his/her cost of care (5.8.7). Expenses that cannot be counted are listed in 4.9.8.2.
When s/he meets the deductible, she can be certified to the end of the deductible period. At the end of the deductible period, redetermine his/her eligibility using the institutional financial tests.
When a fiscal test group has a deductible and individual members have an FFU deductible, the client may choose which deductible s/he wants for each individual.
This page last updated in Release Number: 02-01
Release Date:01-01-02
Effective Date:01-01-02