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5.1.7 Process

5.1.7.1 Hierarchy

5.1.7.2 EBD Cascade

5.1.7.3 Family Cascade

5.1.7.3.1 Child Under 6

5.1.7.3.2 Child 6 through 18

5.1.7.3.3  18-Year-Olds

5.1.7.3.4 Pregnant Woman

5.1.7.3.5 FFU

 

Run the fiscal test group through the cascade The MA cascade is the hierarchy of eligibility. .  Test for categorically ( ca) needy first all the way through ( except FFU ).  Then go back and test if medically ( med ) needy at each step of the cascade.

 

Cat Needy - People are eligible using lower asset and income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. limits.

 

Med Needy - People are eligible using higher asset and income limits.

 

5.1.7.1 Hierarchy

Below is the cascade hierarchy that incorporates EBD MA and Family MA.  If you have a mixed family, follow this cascade.  Once you find someone eligible, you do not have to continue testing his or her eligibility.  Continue to test remaining group members.

 

  1. MA Institutions Cat Needy Protected  ( MI C, MI D, MI W, MI T )

  2. MA Institutions Cat Needy (MI S, MI M, MI A, MI P, MI R)

  3. MA Institutions Med Needy Protected (MI C, MI D, MI W, MI T)

  4. MA Institutions Med Needy (MI S, MI P, MI R)

  5. AFDC-MA AFDC-MA is the category of Medicaid that is based on rules for the Aid to Families with Dependant Children Program (AFDC) that were in effect on July 16, 1996. (MA U or MA R)

  6. MA Extension Cat Needy (ME I, ME C, ME T, ME D)

  7. Continuously Eligible Newborn Cat Needy (MN)

  8. AFDC-Related Cat Needy (MAOU, MAOR)

  9. Pregnancy Extension Cat Needy (ME P)

  10. Healthy Start Cat Needy  (MHSP, MHSC, MHSN,)

  11. SSI-Related Protected MA Cat Needy (MP C, MP D, MP W, MP T)

  12. SSI-Related Cat Needy (MS)

  13. AFDC-Related Med Needy (NAOR)

  14. Continuously Eligible Newborn Med Needy (NN)

  15. Healthy Start Med Needy (NHSC, NHSP)

  16. Pregnancy Extension (NE P)

  17. SSI-Related Protected MA Med Needy (NP C, NP D, NP W, NP T)

  18. SSI-Related Med Needy (NS)

  19. AFDC-Related Med Needy Deductible (NAOR MD)

  20. Healthy Start Med Needy Deductible (NHSC MD)

  21. SSI-Related Med Needy Deductible (NS MD)

  22. 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.)

  23. BadgerCare (BC)

  24. Community Waivers: CIP IA  (MCWA)

Community Waivers: CIP IB (MCWB)

Community Waivers: CIP II  (MCWE) Community Waivers: COP Community Options Program Waiver (MCWW)

Community Care for Elderly (CCE)

Community Supported Living Arrangement (CSLA)

Brain Injury Waiver (MCWI)

PACE (MCWP)

Partnership (MCWR)
 

  1. Family Planning Waiver (FPW)

  2. QMB only (QMB, QMBN)

  3. SLMB only (SLB)

  4. SLMB+ (qualifying individuals 1)

  5. ALMB (qualifying individuals 2)

  6. QDWI only (QDWI)

  7. Family Care Non-MA

 

5.1.7.2 EBD Cascade

Use this cascade when you have an Elderly, Blind, Disabled ( EBD ) case that does not include anyone potentially eligible for Family MA.  

 

Institutions Cat Needy Protected

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Institutions Cat Needy

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Institutions Med Needy Protected

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Institutions Med Needy

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SSI-Related Cat Needy Protected

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SSI-Related Cat Needy

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SSI-Related Med Needy Protected

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SSI-Related Med Needy

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SSI-Related Med Needy Deductible

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Medicaid Purchase Plan ( MAPP )

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Community Waivers

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TB-Related

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 QMB

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SLMB

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SLMB+

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ALMB

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QDWI

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Family Care Non-MA

 

5.1.7.3 Family Cascade

Use this cascade when testing MA for children, caretaker relatives and pregnant women.  If you have someone else in the case who is EBD use the cascade at 5.1.7.1.

 

 

Run the FTG through the cascade.  Test cat needy first all the way through ( except FFU ).  Then go back and test if med needy at each step of the cascade.  After you test MAOU and MAOR ( AFDC-Related cat needy ), the process changes dependent upon the child’s age or if a group member is pregnant.  

 

5.1.7.3.1 Child Under 6

Test the child for Healthy Start following this sequence:

MA R/MA U, MAOR/MAOU, MN, MHSC, NN, and then NHSC.  Do not test this child for AFDC-Related med needy (NAOR).  If the child fails, then go to FFU if applicable (4.8.1).  If s/he fails FFU, determine the deductible.

5.1.7.3.2 Child 6 through 18

Test the child ( ages 6 through 18 ) for Healthy Start if they fail MAOU/MAOR.  If the FTG fails, then go to FFU, if applicable (4.8.1).  If they fail MHSN, there is no med needy Healthy Start test.  S/he can only be eligible by meeting a AFDC-Related deductible.  Use the AFDC-Related med needy limit to determine the deductible amount for the child.

5.1.7.3.3  18-Year-Olds

An 18-year-old is an adult so parents are not legally responsible for them.  Determine their eligibility without counting the parent’s income.  Include an 18-year-old’s spouse in the FTG if the spouse is living with the 18-year-old.  

 

If parents or caretaker relatives of an 18-year-old want MA, they can be eligible if the following three are true:

 

  1. They are living with the 18-year-old.

  2. They request to be included in the group.

  3. The group meets all other non-financial and financial requirements.

 

The following programs have some additional requirements:

 

 

If the group with the parents/caretaker relative fails financial requirements, test the 18-year-old separately.  S/he can be determined as cat needy or med needy for AFDC-Related MA if s/he met the dependent 18-year-old criteria.

 

If the 18-year-old is not a dependent 18-year-old, only test for cat needy AFDC-Related MA, Healthy Start and BadgerCare.

 

If the 18-year-old is blind, disabled, pregnant, or a parent caretaker of a minor, then test eligibility for the relevant category of MA.  

 

Disregard the earned income of 18-year-olds who meet the criteria listed in 4.1.5.9.  

5.1.7.3.4 Pregnant Woman

Test a pregnant woman for MA U/MA R.  If she fails MAOU/MAOR, go to Healthy Start cat needy ( MHSP ).  If she fails, test her following this sequence:  ME P, NHSP, and NE P.  If she fails all of those, go to Family Fiscal Unit ( FFU ) testing.  If she fails FFU, determine the deductible.

5.1.7.3.5 FFU

The Family Fiscal Unit ( FFU ) policy is an individual-based test of eligibility.  

 

Apply the FFU test if the AG fails regular AFDC-Related and Healthy Start testing because of income, and only if the group contains a:

 

  1. Pregnant woman.

  2. Child with income.

  3. Stepparent.

  4. Non-Marital Co-Parent ( NMCP ).

  5. Non-Legally Responsible ( NLRR ) child.

 

See Chapter 4.8.1.

 

 

This page last updated in Release Number : 03-01

Release Date : 01/01/03

Effective Date : 01/01/03