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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/ |
5.16.5.2 Eligibility Begin Date
The benefit period for SC is 12 consecutive months. The benefit period and eligibility remain intact unless the participant :
Moves out of state,
Reapplies (5.16.11),
Requests to withdraw from the program (5.16.12.1), or
Dies.
When an applicant is found eligible for SC, s/he is mailed a plastic SeniorCare ID card and information about how to use it. SC participants who renew their eligibility will continue to use their original card.
SC begins on the first day of the month following the month in which all eligibility requirements have been met.
Exception: SC eligibility begins the day after MA eligibility ends if a SC application is submitted prior to the MA termination date and all eligibility requirements are met.
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Example 1: Carol applies for SC on September 19th and meets all eligibility requirements. Her application is processed on October 10th, and eligibility is confirmed the same day. Carol’s benefit period is from October 1st through September 30th. |
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Example 2: William applied for SC on September 19th but did not submit the enrollment fee with his application. His eligibility “pends” and a notice is issued. William submits the fee on October 1st and eligibility is confirmed the same day. William’s benefit period is from November 1st through October 31st. |
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Example 3: Mary is notified that MA eligibility will end on November 30th because her assets exceed the limit. She applied for SC on November 29th and will meet all SC eligibility requirements on December 1st (when she is no longer an MA recipient). Mary’s benefit period is from December 1st through November 30th. |
Note: If a gap in coverage of not more than one month occurs due to an agency error, eligibility for a new 12 month benefit period begins the first of the month the completed application is received and all eligibility requirements are met, including payment of the annual enrollment fee.
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Example 4: Harold’s PPRA was mailed to him on December 13th to be completed for his new benefit period, that begins February 1st. The PPRA was mailed to the last known address in CARES which belonged to Harold’s wife Mary who was in a nursing home. Mary passed away on May 2nd of this year and although the local agency worker ended her Medicaid eligibility, the case address was not updated in CARES. Harold has not moved, so he was not required to report a change of address to the SC program. Due to the incorrect address Harold did not receive the PPRA form to complete until late in January. The completed PPRA was received by the SC program on February 10th along with a letter explaining why it was late. Harold’s new SC benefit period is February 1st through January 31st since the one month gap in coverage was due to an agency error. |
This page last updated in Release Number: 05-02
Release Date: 05/10/05
Effective Date: 05/10/05