1 Administration and Eligibility

1.1 Introduction

1.2 Program Administration

1.2.1 Contact Information

1.3 Qualifying Decedents

1.4 Confirming Potential Eligibility

1.5 Posthumous Health Care Application

1.1 Introduction

Wis. Stat. § 49.785

WFCAP Wisconsin Funeral and Cemetery Aids Program is an assistance program to service providers who offer funeral, cremation, and cemetery services to certain decedents (see Section 1.3 Qualifying Decedents), and whose services are not fully compensated by the decedent’s estate, family, or other resources. WFCAP is the payer of last resort. Therefore, service providers are required to make a reasonable effort to exhaust all other funding sources before submitting a WFCAP Application, F-10141.

1.2 Program Administration

The Division of Health Care Access and Accountability administers WFCAP. Administration includes paying funeral and cemetery/crematory service providers in accordance with the payment policies in this manual.

1.2.1 Contact Information

Telephone: 888-859-0611

Fax: 608-266-8317

Email: dhswfcapapplications@wi.gov

Address:

Department of Health Services

Division of Health Care Access and Accountability

Bureau of Fiscal Management

ATT: Wisconsin Funeral and Cemetery Aids Program

PO Box 309

Madison WI  53701-0309

1.3 Qualifying Decedents

DHS may issue WFCAP payments for the unmet funeral and/or cemetery/crematory expenses of a person who, on the date of death, met at least one of the following criteria:

1. W-2 Wisconsin Works participant (paid placement only).

2. Child for whom a CTS Caretaker Supplement or Kinship Care benefit was being made on their behalf.

3. Categorically needy EBD elderly, blind, or disabled-related Medicaid recipient, except for MAPP The Medicaid Purchase Plan (MAPP) offers people with disabilities who are working or interested in working the opportunity to obtain health care coverage through Wisconsin Medicaid..  

4. Parent or caretaker relative receiving BadgerCare Plus with family income that does not exceed 50% of the federal poverty level.  

5. Child receiving foster care or adoption assistance.

6. Child under age six or pregnant woman receiving BadgerCare Plus with family income that does not exceed 185% of the federal poverty level.

7. Child at least age six, but not yet 19, receiving BadgerCare Plus with family income that does not exceed 100% of the federal poverty level.

8. A person eligible for categorically or medically needy institutional Medicaid at the time of death.

9. Home and Community-Based Waiver recipient (Group A, B, and B Plus), including IRIS Include, Respect, I Self-Direct Program, and community waiver MAPW MAPP Waivers; someone in MAPP and waivers..

10. Family Care recipient.

11. Tuberculosis (TB)-related Medicaid recipient.

12. The fetus of a woman in a WFCAP qualifying Medicaid or BadgerCare Plus category as identified in Section 1.3 Qualifying Decedents.

13. Child certified for Katie Beckett Medicaid.

14. Supplemental Security Income (SSI), SSI State Supplement (SSI-SSP) or SSI Medicaid recipient who was a Wisconsin resident.

15. Individual who met a Medicaid deductible and also qualified as a Group A community waiver or Family Care case under Group A rules at the time of death (refer to 9 and 10 above).

Funeral and cemetery/crematory expenses for any individual who does not meet at least one of the above criteria will not receive payment.

Note: When requesting payment for the fetus of a Medicaid recipient, service providers must write "Fetus of" prior to the Medicaid recipient's name and provide all required demographic information for the Medicaid recipient on the application.

1.4 Confirming Potential Eligibility

Providers are encouraged to contact WFCAP after the date of death by phone, fax, or email to check for potential program eligibility before submitting an application. This potential eligibility query is only for determining if the decedent met at least one of the criteria identified in Section 1.3 Qualifying Decedents. WFCAP payment eligibility is determined after review and processing of a complete WFCAP Application, F-10141.

1.5 Posthumous Health Care Application

If a decedent was not enrolled in one of the programs identified in Section 1.3 Qualifying Decedents at the time of death, the service provider may still qualify for a WFCAP payment for the decedent’s expenses if at the time of death or due to the cause of death, the decedent was eligible for Medicaid. Prior to the service provider submitting a WFCAP Application, the decedent’s representative or family must contact the decedent’s income maintenance agency for a posthumous application to determine if the decedent was eligible for Medicaid.

This page last updated in Release Number: 16-02

Release Date: 10/03/2016

Effective Date: 10/03/2016