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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/ |
Complete an Estate Recovery Program Disclosure Form whenever a MA client:
Enters or resides in a nursing home, or
Enters or resides in an inpatient hospital and is required to pay a MA cost of care liability, or
Becomes 55 years old.
Do this even if s/he has zero assets.
Complete the form with information about the client, his/her spouse, and his/her children that are blind, disabled, and under age 21.
Attach a legible copy of the latest property tax bill or a copy of the property deed for any homestead property reported if possible. This may give ERP staff the property’s legal description needed to file a lien.
Request the client or his/her agent to sign the completed form. If s/he will not sign the form:
Sign the form at the “Client Signature” line.
Note near your signature that you reviewed the data with the person or his/her agent. Indicate:
That s/he did or did not agree the data was accurate.
The reason s/he did not sign.
In a mail-in application situation, document if the form was not returned or was returned without a signature.
Send the completed form to the ERP. File a copy in the case record.
You need not update this form unless there is a substantial change in circumstances (for example, an inheritance).
This page last updated in Release Number : 05-03
Release Date: 08/29/05
Effective Date: 08/29/05
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