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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/ |
5.7.9.1 Good Cause for Quitting BC
5.7.9.2 Good Cause for Non-Payment
An AG who owes a premium for the current month who leaves BC by quitting or not paying a premium may be subject to a restrictive re-enrollment period. A restrictive re-enrollment period ( RRP ) means the BC AG cannot re-enroll in BC for six months from the termination date.
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Example 1: The client had an income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. increase which leads to a November premium. Previously she did not owe a premium. S/he tells the worker October 20th, ( after Adverse Action ), that s/he does not want BC for November. Since the client does not owe a premium in October, s/he does not receive an RRP, even though s/he will receive an additional month of BC in November. (It is too late to close BC for November.)
Note: If she does not pay the November premium, she will have to pay it before she can be eligible for BC again (5.7.8.4).
For this same case, the client does not tell the worker until November 2nd that they do not want BC for November. Since the client owes a premium in the current month of November, s/he does receive an RRP beginning in December. |
Do not apply the RRP when an AG who owes a premium for Quitting BC the current month voluntarily quits BC for these reasons:
No person is non-financially eligible for BC.
The AG moved out of Wisconsin.
Health insurance became available for the AG.
Entire AG is now MA eligible.
The AG has an increase in income that makes them BC ineligible.
Good cause reasons for not paying the BC premium are:
Problems with the financial institution.
System problem.
Local agency problem.
Wage withholding problem.
Fair hearing decision.
The client must still pay the arrears before eligibility will begin again.
End the RRP when an adult member of the former BC AG leaves the home during the RRP for one full calendar month. Begin BC eligibility the first of the month after the month the adult left. The BC AG must pay any arrears before eligibility starts again. The AG does not have to make payments for months they were ineligible.
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Example: Dad leaves the home on May 20th. On June 20th he has been out of the home a full calendar month. Mom and the kids may be BC eligible starting July 1st. |
An AG who applies for BC before the end of the RRP is ineligible. The AG must serve the full six-month penalty period. Eligibility may begin again in month seven. Exceptions are found in 5.7.9.1, 5.7.9.2 and 5.7.9.3.
S/he must pay all arrears for months s/he was eligible. After the client has been off BC for 12 months, the arrears are forgiven.
This page last updated in Release Number: 03-02
Release Date: 01/01/03
Effective Date: 01/01/03
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