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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/ |
5.16.2.1 Application Processing
5.16.2.2 Signing the Application
5.16.2.2.1 Witnessing the Signature
5.16.2.3 Authorized Representative
5.16.2.4 Guardian and Power of Attorney
An individual interested in participating in SC must complete a SeniorCare Application Form (HCF 10076). An application may be obtained from a local Office on Aging, Senior Center, or Aging Resource Center. Applications may also be printed from the Department of Health and Family Services web site at: http://www.dhs.wisconsin.gov/seniorcare/index.htm. If the applicant is unsure where to obtain an application or wants to have one mailed to him/her, s/he should call 1-800- 657-2038 ( TTY and translation services are available).
A $30 enrollment fee is required as a condition of eligibility. If the enrollment fee is not sent with the application, the eligibility begin date could be delayed (5.16.5.1).
SC applications should be mailed to:
SeniorCare
P.O. Box 6710
Madison, WI 53716-0710
NOTE: For benefit renewal requirements, see 5.16.15.
A valid application for SeniorCare is a SeniorCare Application Form ( HCF 10076 ) with the applicant’s:
Name, and
Address, and
Signature (5.16.2.2) in Section V. Applications that are not signed in Section V of HCF 10076 will be returned to the applicant. (Section VI of the 07/02 version of HCF 10076 )
However, non-financial (5.16.3) 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.(5.16.6) information is needed to determine eligibility.
“General Delivery” may be used for a mailing address but can not be used as a residence address.
The presence of a signature on a SC application indicates intent to apply. When a signed application is received without an enrollment fee, the department will send an enrollment fee request notice to the applicant(s). An application will not be approved until an enrollment fee is received.
When an application is received with an enrollment fee(s) where the applicant(s) has answered “No” to the question “Are you Requesting SeniorCare?”, the department will assume that there is a request for at least one person. When an application is received without the enrollment fee where the applicant’s answer to the question is “No”, the department will follow up with the applicant(s) to determine his/her intent.
The date a valid application is received by the SC program is the application filing date. Eligibility for SC will be determined as soon as possible, but not later than 30 days from the date a valid application is received.
A delay in processing the application may occur if there is a delay in obtaining information or in receipt of the enrollment fee necessary for determining eligibility. If a delay occurs, the applicant will be notified in writing that there is a delay in processing the application. The notice will specify the reason for the delay and inform the applicant of his/her right to appeal the delay.
If the initial application is denied and the applicant wishes to reapply, s/he should check the “New Application” box on the application form. “Reapplication” refers to current participants who are requesting establishment of a new benefit period due to a change in circumstances.
The applicant must sign the application form in Section V of HCF 10076 (Section VI of the 07/02 version of HCF 10076 ) with his/her signature, a mark or an “X”, unless one of the following signs for him/her:
A guardian.
An authorized representative.
A power of attorney/durable power of attorney. (Health Care Power of Attorney is not accepted as proof of authority.)
If a SC applicant signs the application form in Section V of HCF 10076 with a mark or an “X”, the signature must be witnessed by two individuals. (Section VI of the 07/02 version of HCF 10076 )
An authorized representative may act on behalf of the SC participant at application and/or reviews, and is authorized to provide information and any documentation that is necessary to establish SC eligibility.
A SC applicant may authorize someone to represent him/her by completing the authorized representative form HCF 10080. (Note: The early version of SC application included Section V for authorizing a representative. If the 07/02 version of HCF 10076 is submitted with Section V completed, SC will accept the authorization of the representative.)
An applicant is not required to complete the Authorized Representative form HCF 10080 if a legal guardian or power of attorney ( POA ) is applying on the SC applicant’s behalf.
Copies of guardianship or POA documentation will be requested after the SC application has been submitted. Documentation must be submitted to the SC Program before information about the applicant or participant will be released to the guardian or POA. A POA may also be authorized for representation by completing the authorization of representation form ( HCF 10080 ) SeniorCare Authorization of Information in lieu of submitting the POA papers.
This page last updated in Release Number: 04-02
Release Date: 04/30/04
Effective Date: 04/30/04