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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/ |
5.13.6.2.1 Adverse Action Disenrollment
5.13.6.3 Re-enrollment in Family Care
The enrollment date is always the date that the client is enrolled in the CMO. The Resource Center worker provides the IM worker with this information.
Determine Family Care eligibility for a person who received urgent services as of the date the CMO began providing services. The CMO is paid the capitated rate as of that date, if the person is found eligible and chooses to enroll.
If the person is found ineligible for Family Care, the CMO bills the client for the care and urgent services it provided.
A full MA application or review is not necessary for an SSI recipient who asks to enroll in Family Care, and is not applying for FoodShares. The RC worker will supply the IM worker with the following information:
Name.
Residence Address.
Mailing Address.
SSN (and MAID number if different).
Sex.
Primary Language (English or Spanish).
Guardian/Power of Attorney Name and Address.
Date of Birth.
Race (Optional)
Citizenship Status (Alien registration number, if not a citizen).
Disability Status (if not age 65 or older).
All information necessary to complete screens ANCW, AFME, ANMC and ANFR.
They may use the “Model Agency Referral Form” to provide this information. Workers can contact clients as needed for additional information.
CARES Client Assistance for Re-employment & Economic Support populates the date when there is ineligibility for FC. It is not worker enterable. The date will be an end of month date according to adverse action logic, except when the client dies. In this case, the disenrollment date is the date of death.
If a client asks to disenroll prior to the date set according to adverse action logic, fax the paper disenrollment form to the DHCF Enrollment Specialist at (608) 261-7793. The request will then be forwarded to EDS for entry in MMIS.
Family Care enrollees who lose Medicaid eligibility, reapply and again are found eligible for Medicaid may be re- enrolled in Family Care for up to three calendar months prior to the Medicaid application month, only if all of the following conditions are met:
The person (or his/her representative) requests backdated Medicaid.
The person is determined to have met Medicaid financial and non-financial requirements in the month(s) being considered for re-enrollment in Family Care.
The person is determined to have been functionally eligible for Family Care in the month(s) being considered for re-enrollment in Family Care.
The person is determined to have received services, in addition to care management, under the Family Care Care Management Organization’s (CMO) plan of care during the month(s) being considered for re-enrollment in Family Care.
The local income maintenance (IM) agency is not authorized to re-enroll anyone in Family Care earlier than the first of the month, three months prior to the application month.
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Example 1: Richard was enrolled in Family Care until he lost his Medicaid eligibility on January 31, 2007. On May 11, 2007, he filed a new application for Medicaid with the county income maintenance agency, requesting backdated eligibility. Richard’s IM worker determines that:
Richard may be re-enrolled in Family Care back to February 1, 2007 covering the entire three month period. |
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Example 2: Elizabeth was enrolled in Family Care until she lost her Medicaid eligibility on January 31, 2007. On May 11, 2007, she filed a new application for Medicaid with the county income maintenance agency requesting backdated eligibility. Elizabeth’s IM worker determines that:
Elizabeth may be re-enrolled in Family Care only back to April 1, 2007. Her non-waiver EBD Medicaid eligibility may, however, be backdated to February 1, 2007. |
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Example 3: Andrew was enrolled in Family Care until he lost his Medicaid eligibility on December 31, 2006. On May 11, 2007, he filed a new application for Medicaid with the county income maintenance agency requesting backdated eligibility to January. Andrew’s IM worker determines that:
Andrew may be re-enrolled in Family Care to February 1, 2007, covering the period from February through April. |
When a FC enrollee moves permanently to a non-CMO county, s/he can remain enrolled in the CMO only if the Resource Center worker informs IM that the following four conditions are met:
S/he is eligible for COP Community Options Program or waiver services.
After moving to the new county, the enrollee resides in a long-term care facility ( Nursing Home, CBRF, or AFH ).
The enrollee’s placement in the long-term care facility is done under and pursuant to a plan of care approved by the CMO.
The enrollee resided in the CMO county for at least six months prior to the date on which s/he moved to the non-CMO county.
This page last updated in Release Number: 07-05
Release Date: 07/10/07
Effective Date: 07/10/07