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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/ |
5.2.6.5 Children in an Institution
Begin Date. Backdate the certification to the first of the month, three months before the month of application. If the pregnancy is more recent, backdate to the first of the month in which the pregnancy began.
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 met all eligibility requirements during the retroactive period.
End Date. A pregnant woman stays eligible for the balance of the pregnancy and for an additional 60 days. Eligibility continues to the end of the month in which the 60th day occurs (5.6.5).
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Example: A pregnant woman and her ten-year-old child apply on January 15, 1993. She fails regular categorically needy MA, but qualifies for Healthy Start categorically needy. She delivers on March 10, 1993. Sixty days after the last day of pregnancy is May 9, 1993. Her eligibility continues through May 31, 1993. |
During the pregnancy and 60-day extension, an increase in family income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. does not cause her to lose MA. Once found eligible, she remains income eligible for the pregnancy and 60 day extension. She does not have to meet a deductible for any months after she is found eligible.
If a BC case closes due to excess income prior to the end of the pregnancy, certify the pregnant woman manually using the PW or P1 med stat code. If the BC case closes during the 60-day extension period, use the E3 or E4 med stat code.
If she moves to another state during the 60-day extension period, her eligibility ends. Reinstate the extension, if she moves back into the state and becomes a resident again.
If the time period of the extension expires while the person is out-of-state, she does not regain the extension.
Begin Date. For a newborn child, MA begins on the date of birth. It does not matter when the birth was reported.
End Date. The MA end date is:
The end of the month in which the child turns one-year-old, or
The date the child ceases to live continuously with his/her natural mother, or
The date s/he becomes non-financially ineligible.
Changes in the fiscal group's income have no effect on the child's eligibility during the certification period.
Begin Date. The MA begin date is the first day of the month in which the child meets all eligibility factors.
End Date. The child remains eligible through the end of the month in which his/her sixth birthday occurs. S/he must continue to meet the Healthy Start income test.
If s/he fails the Healthy Start medically needy income test anytime before his/her sixth birthday, close the case. On the day the child turns six, apply the six or over limits (8.1.6).
Begin Date. The MA begin date is the first day of the month in which the child meets all eligibility factors.
End Date. Certify through the next review, or as long as all non-financial and financial eligibility factors remain unchanged.
A Healthy Start child of any age who resides in an acute care hospital remains eligible until the end of his/her stay. Disregard changes in income.
If s/he is an inpatient in a facility other than an acute care hospital, test him/her as an institutionalized child first. Certify him/her under Healthy Start only if s/he fails as an institutionalized child.
This page last updated in Release Number: 03-02
Release Date: 04/01/03
Effective Date: 04/01/03