Applications and Reviews> 2 Applications

2.1 APPLICATIONS

2.1 Applications Introduction

2.1.1 Affirmative Action and Civil Rights

2.2 Application Types/Methods

2.3 Where to Apply

2.3.1 Intercounty Placements

2.3.2 Applications Outside Wisconsin

2.4 Valid Application

2.5 Valid Signature   

2.5.1 Witnessing the Signature

2.6 Filing Date

2.7 Timeframes

2.7.1 Changes

2.8 Begin Dates

2.8.1 Backdated Eligibility

2.9 Denials and Terminations

2.9.1 Termination

2.9.2 Denial

2.1 Applications Introduction

Anyone has the right to apply for Medicaid. However, individuals under 18 years of age must have a parent or a legal guardian apply for Medicaid on his/her behalf unless s/he is living independently.

The may be assisted by any person s/he chooses in completing an application.

Note:  Individuals less than 18 years of age have the right to apply for Medicaid Family Planning Services on his/her own behalf.

Encourage anyone who expresses interest in applying to file an application as soon as possible.  When an application is requested:

1. Suggest the applicant use the ACCESS online application at the following site  http://ACCESS.wisconsin.gov ; or

2. Mail the paper application form; or

3. Schedule a telephone or face-to-face interview.  

Provide any information, instruction and/or materials needed to complete the application process.  Provide a Notice of Assignment:  Child Support, Family Support, Maintenance and Medical Support form ( DWSW 2477 ) and Good Cause Claim form  ( DWSW 2018 ) to each applicant with children applying for Medicaid or to anyone that requests either of these.

Refer requests for applications and other outreach materials from groups and persons involved in outreach efforts to:

http://dhfs.wisconsin.gov/forms/paperfpc.htm

Note: An application can be filed on behalf of a deceased person. If the application is filed within the same calendar month as the date of death or within the 3 months after the date of death, the application should be processed as if the applicant were alive.  If the application is filed more than 4 months after the date of death, s/he is not eligible.

2.1.1 Affirmative Action and Civil Rights

The Rehabilitation Act of 1973 requires a person with impaired sensory, manual, or speaking skills have an opportunity to participate in programs equivalent to those afforded non-disabled persons.

Notify clients during intake that assistance is available to assure effective communication.  This includes certified interpreters for deaf persons and translators for non-English speaking persons.  See the Wisconsin Medicaid Eligibility and Benefits brochure ( PHC 10025 ).

The Civil Rights Act of 1964 requires that applicants for public assistance have an equal opportunity to participate regardless of race, color, or national origin.

2.2 Applications Types/ Methods

Medicaid applicants have the choice of one of the four following methods:

1. ACCESS https://access.wisconsin.gov/access/

2. Mail-In using the Wisconsin Medicaid for the Elderly, Blind,and Disabled Application Packet (HCF 10101).

3. Telephone Interview.

4. Face-to-Face Interview.

2.3 Where to Apply

The applicant must apply in the county in which s/he resides.  Click here to view the Directory of local county/tribal agencies in Wisconsin or call 1 (800) 362-3002.

An individual who resides in a nursing home/ hospital for 30 days or more and will have his or her Medicaid eligibility determined as an institutionalized person is a resident of the county in which the nursing home/hospital is located.

The applicant’s county of residence at the time of admission must receive and process applications for persons in these state institutions:

1. Northern, Central, and Southern Centers.

2. Winnebago and Mendota Mental Health Institutes.

3. The University of Wisconsin Hospital.

Waupaca County receives and processes all applications and reviews for residents of the Wisconsin Veterans Home at King, regardless of the county of residence.

When an applicant contacts the wrong agency, redirect him/her to the agency responsible for processing the applicationimmediately.   Anytime an application is received in the wrong agency, it must be date stamped and redirected to the agency responsible for processing that application no later than the next business day.  The filing date remains the date originally received by the wrong agency.

2.3.1 Intercounty Placements

When a county 51.42 board, 51.437 board, human services department or social services department places a person in a congregate care facility that is located in another county, the placing county remains responsible for determining and reviewing the applicant’s Medicaid eligibility.  A congregate care facility is a:

1. Child care institution.

2. Group home.

3. Foster home.

4. Nursing home.

5. Adult Family Home ( AFH ).

6. Community Based Residential Facility ( CBRF ).

7. Any other like facility.

The placing county may request the assistance of the receiving county in completing applications for persons who are not enrolled in Medicaid and reviews for Medicaid members.  The receiving county must then forward the information to the placing county.  The placing county remains responsible for determining the applicant’s eligibility.  If the placing county requests assistance from the receiving county, the placing county must provide the other agency with:

1. The applicant’s name, age, and SSN.

2. The date of placement.

3. The applicant’s current Medicaid status.

4. The name and address of the congregate care facility in which the applicant has been placed.

5. The name of the county and agency making the placement.

When there is a dispute about responsibility, the social or human services department of the receiving county may initiate referral to the Department of Health and Family Services' Area Administration office for resolution. Pending a decision, the county where the person is physically present must process the application, any changes, and reviews.

2.3.2 Applications Outside Wisconsin

Generally, an application should not be taken for a resident of Wisconsin when s/he is living outside of Wisconsin.  An exception is when a Wisconsin resident becomes ill or injured outside of the state or is taken out of the state for medical treatment.  In this case, the application may be taken, using Wisconsin’s application forms (2.1), by the public welfare agency in the other state.  The forms should  be forwarded to the Income Maintenance agency in the other state.  The Wisconsin IM agency determines eligibility when the forms are returned.

2.4 Valid Application

A valid applicationfor Medicaid must include the applicant’s:

1. Name,

2. Address, and

3. A valid signature

The date the application is received by the IM agency with the applicant’s name, address and a valid signature is the filing date,  Applications must be processed within 30 days of the filing date.  (See 2.7)

2.5 Valid Signature

The applicantor the applicant's caretaker relative must sign (using his/her own signature):

1. The paper application form,

2. The signature page of the CAF (telephone or face to face) or

3. The ACCESS application form with an electronic signature.  

Except when:

1. A guardian signs for him/her.  When an application is submitted with a signature of someone claiming to be the applicant’s guardian, obtain a copy of the document that designates the signer of the application as the guardian.   From the documents provided, ensure that the individual claiming to be the applicant’s guardian can file an application on his/her behalf.  Scan the copy of the document in the Electronic Case File.

Your agency’s social services department determines the need for a guardian or conservator (IMM, Ch. I, Part A, 19.0.0).  Determine the guardian type specified by the court.

Only the person designated as the guardian of the estate (IMM, Ch. I, Part A, 19.2.0), guardian of the person and the estate, or guardian in general may sign the application.  You may not require a conservator (IMM, Ch. I, Part A, 19.4.0) or guardian of the person (IMM, Ch. I, Part A, 19.1.0) to sign the application.

2. An authorized representativesigns for the applicant. The applicant may authorize someone to represent him/her (IMM, Ch. I, Part A, 18.3.0). An authorized representative must be an individual, not an organization.

If the applicant wishes to authorize someone to represent him/her when applying by mail, instruct him/her to complete the authorized representative section of the application form.

If the applicant needs to appoint an authorized representative when applying by telephone or in person, instruct the applicant to complete the Authorization of Representative form ( HCF 10126 ).  

An authorized representative is responsible for submitting the signed application (completed insofar as able) and any required documents.

When appointing an authorized representative, someone other than the authorized representative must witness the applicant’s signature.  If the applicant signs with a mark, two witness signatures are required.

3. The applicant’s durable power of attorney (§ 243.07, Wis. Stats.) signs the application.  A durable power of attorney is a person to whom the applicant has given power of attorney authority and agrees that the authority will continue even if the applicant later becomes disabled or otherwise incapacitated.

When a submitted application is signed by someone claiming to be the applicant’s durable power of attorney:

1. Obtain a copy of the document the applicant used to designate the signer of the application as the durable power of attorney.

2. Review the document for a reference that indicates the power of attorney authority continues notwithstanding any subsequent disability or incapacity of the applicant.

Do not consider the application properly signed unless both of these conditions are met.  File a copy of the document in the case record.  An individual's Durable Power of Attorney may appoint an authorized representative for purposes of making a Medicaid application if authorized on the power of attorney form. The Durable Power of Attorney Form will specify what authority is granted.  

The appointment of a Durable Power of Attorney does not prevent an individual from filing his/her own application for Medicaid nor does it prevent the individual from granting authority to someone else, to apply for public assistance on his/her behalf.

4. Someone acting responsibly for the individual signs the form on behalf of the individual, if the individual is incompetent or incapacitated.

5. A superintendent of a state mental health institute or center for the developmentally disabled signs on behalf of a patient.  

6. A warden signs the application for an applicant that is an inmate of a state correctional institution that is out for more than 24 hours.

7. The director of a county social or human services department delegates, in writing (retain a copy of this written authorization), to the superintendent of the county psychiatric institution the authority to sign and witness an application for residents of the institution.  

The social or human services director may end the delegation when there’s reason to believe that the delegated authority is not being carried out properly.

2.5.1 Witnessing the Signature

The signatures of two witnesses are required when the application is signed with a mark.

An agency staff person is not required to witness the signature of a mail-in, online or telephone application.   

Note:  This does not affect the State of Wisconsin’s ability to prosecute for fraud nor does it prevent the Medicaid program from recovering benefits provided incorrectly due to an applicant or member’s misstatement or omission of fact.

2.6 Filing Date

The filing dateis the day a signed valid/registration form is delivered to the Income Maintenance agency or the next business day if it is delivered after the agency's regularly scheduled business hours.

The filing date on an ACCESS application is the date the application is electronically submitted or the next business day if submitted after 4:30 PM or on a weekend or holiday.

When an application is submitted by mail or fax, record the date that the IM agency received the valid application form.

When a request for assistance is made by phone, the filing date is not set until a signed application and/or page oneis received by the agency.  

2.7 Timeframes

All applications received by an agency must be processed and eligibility approved or denied as soon as possible but no later than 30 calendar days from the filing date This includes issuing a notice of decision.

IM workers should not delay eligibility for an individual in a household when waiting for another household member's citizenship or identity verification. The individual pending for citizenship/identity should be counted as part of the group when determining eligibility for other group members. (See Chapter 2)

Extend the 30-day processing time up to an additional 10 days if you are waiting for the applicantto provide additional information.  CARESwill issue a pending notice indicating the reason for the delay when appropriate entries are made on the Verification Due Page.

Deny the applicationfor failure to provide information or verification if:

1. Requested information or verification is required by program policy to determine eligibility (Chapter 9), and

2. The applicant had the power to produce the information or verification within the period, but failed to do so, and

3. The applicant had a minimum of 10 days to produce the verification.  

If the agency fails to take action (positive or negative) during the 30-day processing period, and the applicant is subsequently found eligible, determine eligibility using the original filing date.

2.7.1 Changes

Changes that occur between the filing date and the confirmation date should be used in the initial eligibility determination.  

For changes that occur after the confirmation date, follow the adequate and timely notice requirements outlined in IMM Chapter 1.2.2.

2.8 Begin Dates

Medicaid  eligibility begins the first day of the month in which the valid application is submitted and all eligibility requirements are met with the following exceptions.  Those begin dates are the date a valid application is submitted, all eligibility requirements are met, and:  

1. Deductible - The date the deductible was met.

2. Inmates –The date the member is no longer an inmate of a public institution.

3. Person Adds - The date the person moved into the household.

4. Recent Moves - The date the member moved to Wisconsin

Exception: The begin date for an SSI recipient who moves to Wisconsin is the 1st of the month of the move.

5. Home and Community Based Waivers: The program start date provided by the care manager.

6. Family Care and Pace or Partnership-the date the individual is enrolled in the Managed Care Organization.

7. Institutionalized - His/her entry into the nursing home or hospital.

8. QMB - The first of the month following the eligibility determination

9. SeniorCare – The first of the month following the month in which all eligibility requirements have been met

2.8.1 Backdated Eligibility

If certifying for retroactive Medicaid, do not go back further than the first of the month, three months prior to the application month.  Certify the person for any backdate month in which s/he would have been eligible had s/he applied in that month.

A backdate request can be made at any time, except in the case where the member is already enrolled and backdating the member’s eligibility would result in a deductible for the backdated period.  

If a member has incurred a bill from a Medicaid certified provider during a backdate period, instruct the member to contact the provider to inform them to bill Medicaid. The member may be eligible to receive a refund, up to the amount already paid to the provider.

2.9 Terminations and Denials

2.9.1 Termination

If less than a calendar month has passed since a member’s enrollment has been terminated, the applicantcan provide the necessary information to reopen Medicaid without filing a new application

If more than a calendar month has passed since a member’s enrollment was terminated, the applicant must file a new application to reopen his/her Medicaid

2.9.2 Denial

If less than 30 days has passed since the application was denied, allow the applicant to re-sign and date the application to set a new filing date.

If the applicant is currently eligible for any other program of assistance, do not require him/her to re-sign his/her application or sign a new application.

If more than 30 days has passed since an application was denied, the applicant must file a new application to reopen his/her Medicaid.

This page last updated in Release Number: 04-02

Release Date: 07/01/03

Effective Date: 07/01/03