Register January 2021 No. 781
Chapter DHS 103
Non-financial conditions for eligibility.
Asset and income limits.
Determining assets and income in child-only cases.
Divestment prior to August 9, 1989.
Divestment on or after August 9, 1989.
Prevention of spousal impoverishment.
Beginning of eligibility.
Conditions for continuation of eligibility for BadgerCare.
Conditions for continuation of eligibility.
Termination of medical assistance.
Redetermination of eligibility.
Presumptive eligibility for pregnant women.
Ch. DHS 103 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Chapter HSS 103 as it existed on February 28, 1986, was repealed and a new chapter HSS 103 was created effective March 1, 1986.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
Eligibility for medical assistance shall be determined pursuant to ss. 49.455
, 49.46 (1)
, 49.47 (4)
, 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
Presumptive eligibility for pregnant women shall be determined under s. 49.465
, Stats., and this chapter.
(2) Singular enrollment.
No person may be certified eligible in more than one MA case.
DHS 103.01 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 Non-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:
(1) AFDC-relatedness, SSI-relatedness or BadgerCare eligibility. DHS 103.03(1)(a)(a)
To be non-financially eligible for MA, an applicant shall be AFDC-related, SSI-related or meet the non-financial requirements under par. (f)
(b) AFDC-related persons.
In this subsection, “AFDC-related" means a person who meets one of the following conditions:
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
(c) SSI-related persons.
In this subsection, “SSI-related person" means a person who meets one of the following conditions:
(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:
By presentation of a current old age and survivors disability insurance (OASDI) disability award notice;
By presentation of a current medicare card indicating blindness or disability; or
By receipt of a disability determination made by the department's bureau of social security disability insurance, along with current medical reports.
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)
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.
Seriously impaired and the attending physician states the applicant will be unable to work or return to normal functioning for at least 12 months;
In need of long-term care and the nursing home will not admit the applicant until MA benefits are in effect; or
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.
To be non-financially eligible for BadgerCare, a person shall meet all of the following conditions:
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.
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:
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.
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.
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.
The person was covered by insurance that has ended due to the death or change in marital status of the subscriber.