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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/ |
5.7.5.5 Ineligible BC Children
5.7.5.6 Adults with Health Insurance
Take those in the test group who are non-financially eligible to the fiscal test. The fiscal test group ( FTG ) includes all:
Household members who are non-financially eligible, and
Test children (5.7.5.3), and
Ineligible household members who are legally responsible for all person(s) listed in #1, except for those who are only legally responsible for test children.
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Example: Cheryl and Eric are not married, and have a child together. Cheryl is requesting MA and BC for herself and their child, Alex. Eric is not requesting BC. Alex is found eligible for Healthy Start. In building the FTG, Alex is a test child because he is receiving MA. Eric is not part of the FTG, because he is only legally responsible for a test child in the FTG. |
Build the BC FTG around the primary person. If the only potentially eligible BC child left is a non-legally responsible relative ( NLRR ) child, build a separate group around the NLRR child. Take the FTG to the income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. tests.
Do not include SSI recipients in the BC test or FTG. Do not count their income.
Include the MA eligible adult in the BC FTG if s/he is legally responsible for a BC test group member. Include his/her income.
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Example: Michelle is pregnant and receiving Healthy Start. She is requesting BC for her son, Steve. Michelle’s income would be included in the eligibility test for BC for Steve, and she would be included in his BC FTG. |
Test children include the minor children that are ineligible for BC solely because of one of the following or any combination of the following:
Are MA eligible, or
Have insurance access, or
Have insurance coverage, or
Are ineligible for BC solely because they receive adoption assistance.
Have an unmet deductible
Do not count the income of the test children, but include these minor children in the FTG as test children. When a child is on MA (other than SSI) in another case s/he can still be considered a test child in their parent's BC case if they are living in the home with them.
Adults Include any ineligible adult who has legal responsibility for someone who passed the non-financial test. Count their income. The exception is SSI recipients.
Do not include ineligible BC children, except for test children (5.7.5.3), in the FTG. Exclude an ineligible child’s income.
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Example: Charlene is requesting MA and BC for three of her children. She is not requesting MA or BC for one of her children, Eric. Eric’s income should not be counted when determining BC eligibility for the other members of the family, and he is not included in the BC FTG. |
Include the adults (legally responsible for a BC test group Insurance member) with health insurance in the fiscal test group.
Anyone may be excluded from BC. Include the income of an excluded adult who is legally responsible for someone in the BC fiscal test group, except test children. If a child is excluded, do not count his/her income or include them in the BC FTG, unless the child is a parent of a child in the home who is eligible for BC. Excluded children include those who are non-financially ineligible for BC for a reason other than access or coverage. Examples are those who are not providing a SSN and SSI recipients.
Increase the FTG size by one for each fetus a pregnant woman is carrying.
If the child is temporarily absent, and the parents have no other children in the home, the parents are ineligible for BC. A child can be temporarily absent and still be eligible for BC.
This page last updated in Release Number : 04-01
Release Date: 02/27/04
Effective Date: 02/27/04