Register June 2017 No. 738
Chapter DHS 103
ELIGIBILITY
DHS 103.01   Introduction.
DHS 103.03   Non-financial conditions for eligibility.
DHS 103.04   Asset and income limits.
DHS 103.05   Determining assets and income in child-only cases.
DHS 103.06   Assets.
DHS 103.063   Divestment prior to August 9, 1989.
DHS 103.065   Divestment on or after August 9, 1989.
DHS 103.07   Income.
DHS 103.075   Prevention of spousal impoverishment.
DHS 103.08   Beginning of eligibility.
DHS 103.085   Conditions for continuation of eligibility for BadgerCare.
DHS 103.087   Conditions for continuation of eligibility.
DHS 103.09   Termination of medical assistance.
DHS 103.10   Redetermination of eligibility.
DHS 103.11   Presumptive eligibility for pregnant women.
Ch. DHS 103 Note Note: Chapter HSS 103 as it existed on February 28, 1986, was repealed and a new chapter HSS 103 was created effective March 1, 1986. Chapter HSS 103 was renumbered Chapter HFS 103 under s. 13.93, Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, January, 1997, No. 493. Chapter HFS 103 was renumbered to chapter DHS 103 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 103.01 DHS 103.01Introduction.
DHS 103.01(1) (1)Persons eligible.
DHS 103.01(1)(a)(a) Eligibility for medical assistance shall be determined pursuant to ss. 49.455, 49.46 (1), 49.47 (4) and 49.472, Stats., and this chapter, except that medical assistance shall be provided without eligibility determination to persons receiving SSI or those persons who would currently be eligible under the AFDC program that was in place on July 16, 1996 in this state pursuant to s. 49.19, Stats.
DHS 103.01(1)(b) (b) Presumptive eligibility for pregnant women shall be determined under s. 49.465, Stats., and this chapter.
DHS 103.01(2) (2)Singular enrollment. No person may be certified eligible in more than one MA case.
DHS 103.01 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; renum. (1) to be (1) (a) and cr. (1) (b), Register, February, 1988, No. 386, eff. 3-1-88; am. (1) (a), Register, March, 1993, No. 447, eff. 4-1-93; emerg. am. (1) (a), eff. 7-1-99; am. (1) (a), Register, March, 2000, No. 531, eff. 4-1-00; am. (1) (a), Register, November, 2000, No. 539, eff. 12-1-00.
DHS 103.03 DHS 103.03Non-financial conditions for eligibility. In order to be eligible for MA, a person shall meet both non-financial conditions for eligibility in this section and financial conditions for eligibility under s. DHS 103.04. The non-financial conditions for eligibility are:
DHS 103.03(1) (1)AFDC-relatedness, SSI-relatedness or BadgerCare eligibility.
DHS 103.03(1)(a)(a) Requirement. To be non-financially eligible for MA, an applicant shall be AFDC-related, SSI-related or meet the non-financial requirements under par. (f) for BadgerCare.
DHS 103.03(1)(b) (b) AFDC-related persons. In this subsection, “AFDC-related" means a person who meets one of the following conditions:
DHS 103.03(1)(b)1. 1. The person is pregnant and meets the conditions specified in s. 49.46 (1) (a) 1m. or 9., 49.465 or 49.47 (4) (ag) 2. or (am) 1., Stats.;
DHS 103.03(1)(b)2. 2. The person is a dependent child as defined in s. 49.19 (1) (a), Stats., or is a child who meets the conditions specified in s. 49.46 (1) (a) 10. or 49.47 (4) (a) 1. or (am) 2., Stats.;
DHS 103.03(1)(b)3. 3. The person is a caretaker relative; or
DHS 103.03(1)(b)4. 4. The person is a foster child under 19 years of age living in a foster home licensed under s. 48.62, Stats., or a group home licensed under s. 48.625, Stats., or is a child in an adoption assistance placement under s. 48.975, Stats.
DHS 103.03(1)(c) (c) SSI-related persons. In this subsection, “SSI-related person" means a person who meets one of the following conditions:
DHS 103.03(1)(c)1. 1. The person is age 65 or over; or
DHS 103.03(1)(c)2. 2. The person is blind or disabled.
DHS 103.03(1)(d) (d) Verification of blindness or disability. Except as provided under par. (e), the blindness or disability claimed under par. (c) 2. shall be verified in one of the following ways:
DHS 103.03(1)(d)1. 1. By presentation of a current old age and survivors disability insurance (OASDI) disability award notice;
DHS 103.03(1)(d)2. 2. By presentation of a current medicare card indicating blindness or disability; or
DHS 103.03(1)(d)3. 3. By receipt of a disability determination made by the department's bureau of social security disability insurance, along with current medical reports.
DHS 103.03(1)(e) (e) Presumption of disability in an emergency.
DHS 103.03(1)(e)1.1. Under emergency circumstances, a person may be presumed disabled for purposes of demonstrating SSI-relatedness and be eligible for MA without the verification required under par. (d).
DHS 103.03(1)(e)2. 2. When an emergency need for MA exists, the department shall make a preliminary disability determination within 7 days of the date a completed disability determination form is received.
DHS 103.03(1)(e)3. 3. An emergency need for MA shall exist when the applicant is:
DHS 103.03(1)(e)3.a. a. A patient in a hospital;
DHS 103.03(1)(e)3.b. b. Seriously impaired and the attending physician states the applicant will be unable to work or return to normal functioning for at least 12 months;
DHS 103.03(1)(e)3.c. c. In need of long-term care and the nursing home will not admit the applicant until MA benefits are in effect; or
DHS 103.03(1)(e)3.d. d. Unable to return home from a nursing home unless in-home service or equipment is available and this cannot be obtained without MA benefits.
DHS 103.03 Note Note: Copies of the disability determination form may be obtained from the county or tribal income maintenance agency.
DHS 103.03(1)(f) (f) BadgerCare eligibility. To be non-financially eligible for BadgerCare, a person shall meet all of the following conditions:
DHS 103.03(1)(f)1. 1. The person is under age 19, a custodial parent living with his or her child who is under age 19 or the spouse of a custodial parent if the spouse resides with the custodial parent's child who is under the age of 19.
DHS 103.03(1)(f)2. 2. The person does not have health insurance coverage and has not been covered at any time in the previous 3 calendar months. The 3 calendar month period does not apply if the coverage ended for a good cause reason. A good cause reason is any of the following:
DHS 103.03(1)(f)2.a. a. The person was covered by a group health insurance plan that was provided by a subscriber through his or her employer, and the subscriber's employment ended for a reason other than voluntary termination, except for cases in which the voluntary termination was a result of the incapacitation of the subscriber.
DHS 103.03(1)(f)2.b. b. The person was covered by a group health insurance plan that was provided by a subscriber through his or her employer, and the subscriber changed to a new employer who does not offer family coverage.
DHS 103.03(1)(f)2.c. c. The person was covered by a group health insurance plan that was provided by a subscriber through his or her employer, and the subscriber's employer discontinued health plan coverage for all employees.
DHS 103.03(1)(f)2.d. d. COBRA continuation coverage was exhausted in accordance with 29 CFR 2590.701-2(4).
DHS 103.03(1)(f)2.e. e. The person was covered by insurance that has ended due to the death or change in marital status of the subscriber.
DHS 103.03(1)(f)2.f. f. Any other reason determined by the department to be a good cause reason.
Loading...
Loading...
Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.