DHS 103.04(9)(a)(a) Medicaid purchase plan group. Any of the following persons who reside in the home with the applicant or recipient shall be included in determining the family size of the person applying for the medicaid purchase plan, with this family size used in calculating the person’s financial eligibility under this section: DHS 103.04(9)(b)(b) Medicaid purchase plan fiscal test group. The income of any person listed in par. (a) 1. or 2. shall be included when determining financial eligibility of the applicant. DHS 103.04(9)(c)1.1. Medical assistance under the medicaid purchase plan applies to the applicant or recipient only. DHS 103.04(9)(c)2.2. The monthly premium for the medicaid purchase plan is calculated using only the income of the applicant or recipient. DHS 103.04 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. (4) (intro.), Register, March, 1993, No. 447, eff. 4-1-93; correction in (1) (a) made under s. 13.93 (2m) (b) 7., Stats., Register, April, 1999, No. 520; emerg. am. (3) (a), eff. 7-1-99; am. (3) (a) and cr. (6) and (7), Register, March, 2000, No. 531, eff. 4-1-00; cr. (8) and (9), Register, November, 2000, No. 539, eff. 12-1-00; corrections in (1) (b), (2), (3) (b) and (5) (e) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; correction in (3) (b) made under s. 13.92 (4) (b) 7., Stats., Register July 2015 No. 715; correction in (1) (b) made under s. 13.92 (4) (b) 7., Stats., Register January 2021 No. 781; CR 20-039: am. (7) (d) Register October 2021 No. 790, eff. 11-1-21; CR 23-046: am. (1) (b), (2), (3) (a), (b), cr. (3) (bg), (br), renum. (5) (a) to (5) and am., r. (5) (b) to (e), am. (6) (title), (a), (b), r. and recr. (7), cr. (8) (b) 4. Register April 2024 No. 820, eff. 5-1-24; correction in (5) (title) made under s. 13.92 (4) (b) 2., Stats., and correction in (7) (b) (intro.), 1. j., 2., (c) 1., made under s. 35.17, Stats., Register April 2024 No. 820. DHS 103.05DHS 103.05 Determining assets and income in child-only cases. DHS 103.05(1)(1) Meaning of child-only case. A child-only case exists when any of the following occur: DHS 103.05(1)(a)(a) A family has been determined financially ineligible for BadgerCare Plus-related MA only and there is a child in the family who is SSI-related but not receiving SSI payments. DHS 103.05(2)(2) Establishing child-only MA groups. In child-only cases, the child or children of each legal parent shall form their own MA group and shall be tested for financial eligibility with the children’s own income and assets, if any, plus the income and assets deemed to the children of this group according to subs. (3) and (4). DHS 103.05(3)(a)(a) All of the legal parent’s nonexempt assets shall be deemed to the child in 3-generation and stepparent cases. DHS 103.05(3)(b)(b) In cases of an SSI-related child where 2 parents are in the home, parental assets in excess of the SSI asset limit for 2 persons shall be deemed to the blind or disabled child. Where there is one parent, parental assets in excess of the SSI asset limit for one person shall be deemed to the blind or disabled child in accordance with 42 CFR 435.845. DHS 103.05(4)(a)(a) To the third-generation child. All of the net income of the second-generation minor parent shall be deemed to the third-generation child. DHS 103.05(4)(b)(b) To the stepchild. The income deemed to the stepchild shall be the remainder of the total of the net income of the legal parent minus the categorically needy income standard based on the number of ineligible family members. DHS 103.05(4)(c)(c) To the SSI-related child. The amount of parental monthly income deemed to the SSI-related child shall be determined according to the procedure set out in this paragraph. The department shall adjust the monthly amounts in accordance with changes in the SSI program. Beginning with unearned income, parental monthly gross income shall be deemed to each ineligible child to bring the child’s income up to an amount equal to one-half the maximum federal share of the SSI benefit paid to a single individual living in his or her own household. The remaining parental income shall be deemed to the SSI-related child as follows: DHS 103.05(4)(c)1.1. When the only type of parental income remaining is unearned, $20 shall be subtracted. Then, where there are 2 parents, an amount equal to the maximum federal share of the SSI benefit paid to a couple living in their own household shall be subtracted, and where there is one parent, an amount equal to the maximum federal share of the SSI benefit paid to an individual living in his or her own household shall be subtracted. The remaining income shall be considered available to the SSI-related child as unearned income. DHS 103.05(4)(c)2.2. When the only type of parental income remaining is earned, $85 shall be subtracted. Then, where there are 2 parents, an amount equal to 3 times the maximum federal share of the SSI benefit paid to an individual living in his or her own household shall be subtracted, and where there is one parent, an amount equal to 2 times the maximum federal share of the SSI benefit paid to an individual living in his or her own household shall be subtracted. The remaining income shall be considered available to the SSI-related child as unearned income. DHS 103.05(4)(c)3.3. When parental income remaining is a mix of unearned and earned, $20 shall be subtracted using unearned income first. From any remaining earned income, $65 shall be subtracted and then one-half of the remainder. When there are 2 parents, an additional amount equal to the maximum federal share of the SSI benefit paid to a couple living in their own household shall be subtracted, and when there is one parent, an additional amount equal to the maximum federal share of the SSI benefit paid to an individual living in his or her own household shall be subtracted. The remaining income shall be considered available to the SSI-related child as unearned income. DHS 103.05(5)(5) Income limits for child-only MA groups. The eligibility of an SSI-related child shall be determined by testing against the SSI-related income standard for one person. DHS 103.05 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; CR 23-046: am. (1) (intro.), (a), r. and recr. (1) (b), r. (1) (c) to (e), r. (5) (a), renum. (5) (b) to (5) Register April 2024 No. 820, eff. 5-1-24. DHS 103.06(1)(1) Special situations of institutionalized persons. DHS 103.06(1)(a)(a) In determining the eligibility of an institutionalized person, only the assets actually available to that person shall be considered. DHS 103.06(1)(b)(b) The homestead property of an institutionalized person is not counted as an asset if: DHS 103.06(1)(b)1.1. The institutionalized person’s home is currently occupied by the institutionalized person’s spouse or a dependent relative. In this subdivision,“dependent relative” means a son, daughter, grandson, granddaughter, stepson, stepdaughter, in-law, mother, father, stepmother, stepfather, grandmother, grandfather, aunt, uncle, sister, brother, stepbrother, stepsister, halfsister, halfbrother, niece, nephew or cousin who is financially, medically or otherwise dependent on the institutionalized person; DHS 103.06(1)(b)2.2. The institutionalized person intends to return to the home and the anticipated absence from the home, as verified by a physician, is less than 12 months; or DHS 103.06(1)(b)3.3. The anticipated absence of the institutionalized person from the home is for more than 12 months but there is a realistic expectation, as verified by a physician, that the person will return to the home. That expectation shall include a determination of the availability of home health care services which would enable the recipient to live at home. DHS 103.06(1)(c)(c) If none of the conditions under par. (b) is met, the property is no longer the principal residence and becomes non-homestead property. DHS 103.06(1)(d)(d) When income that has been protected for institutionalized recipients accumulates to the point that the asset limit is exceeded, MA eligibility shall terminate. Eligibility may not be reinstated until the assets are below the limit at which time a new application shall be required. DHS 103.06(1)(e)(e) To maintain continuous MA eligibility the recipient may apply assets as a refund of MA benefits to the department. In no instance may refunds exceed benefits received. DHS 103.06(2)(a)1.1. “Motor vehicle” means a passenger car or other motor vehicle used to provide transportation of persons or goods and which is owned by a person in the MA or fiscal test group. DHS 103.06(2)(a)2.2. “Equity value” means the fair market value minus any encumbrances which are legal debts. DHS 103.06(2)(a)3.3. “Fair market value” means the wholesale value shown in a standard guide on motor vehicle values or the value as estimated by a reliable expert. DHS 103.06(2)(b)(b) For persons whose eligibility is being determined according to AFDC categorically needy financial standards, the following conditions shall apply: DHS 103.06(2)(b)2.2. If more than one vehicle is owned, up to $1,500 of equity value of the vehicle with the greatest equity value is exempt. The equity value of the vehicle with the greatest equity value in excess of $1,500 and the equity value of any other vehicle is counted as an asset. DHS 103.06(2)(bm)(bm) For persons whose eligibility is being determined according to AFDC medically needy financial standards, the following conditions shall apply: DHS 103.06(2)(bm)1.1. If one vehicle is owned, it is exempt from consideration as an asset regardless of value; DHS 103.06(2)(bm)2.2. If more than one vehicle is owned, a second vehicle is exempt from consideration as an asset if the agency determines that it is necessary for the purpose of employment or to obtain medical care; and DHS 103.06(2)(bm)3.3. The equity value of any nonexempt vehicle owned by the applicant is counted as an asset. DHS 103.06(2)(c)(c) For persons whose eligibility is being determined according to SSI categorically needy or medically needy financial standards, the following conditions shall apply: DHS 103.06(2)(c)1.1. If one vehicle is owned it is exempt if it meets one of the following conditions: DHS 103.06(2)(c)1.b.b. It is necessary for medical treatment of a specific or regular medical problem. DHS 103.06(2)(c)1.c.c. It is modified for operation or transportation of a person with a disability. DHS 103.06(2)(c)1.d.d. It is necessary because of climate, terrain, distance or similar factors to provide transportation to perform essential daily activities. DHS 103.06(2)(c)2.2. If no automobile is exempt under subd. 1., one automobile is not counted as an asset to the extent that its current fair market value does not exceed $4,500. Fair market value in excess of $4,500 counts toward the asset limit. DHS 103.06(2)(c)3.3. If more than one vehicle is owned, the equity value of the nonexempt vehicle is counted as an asset. DHS 103.06(3)(a)(a) Joint accounts. A joint account shall be deemed available to each person whose name is on the account or listed as an owner. The value of a joint savings or checking account shall be determined as follows in determining eligibility for MA: DHS 103.06(3)(a)1.1. For persons who receive MA who are not age 65 or over, or not blind or disabled, the division of a joint account shall be determined according to applicable federal law; and DHS 103.06(3)(a)2.2. For persons who receive MA who are age 65 or over or who are blind or disabled, joint accounts shall be divided as follows: DHS 103.06(3)(a)2.a.a. If both owners of the joint account receive MA, equal shares of the joint account shall be included for the purpose of determining MA eligibility; and DHS 103.06(3)(a)2.b.b. If only one owner of the joint account receives MA, the full amount of the joint account shall be included for the purpose of determining MA eligibility. DHS 103.06(3)(b)(b) Jointly held property. If the applicant or recipient is a joint owner of property with a person who refuses to sell the property and who is not a legally responsible relative of the applicant or recipient, the property shall not be considered available to the applicant or recipient and may not be counted as an asset. If the property is available to the applicant or recipient, it shall be divided equally between the joint owners. DHS 103.06(4)(a)(a) A home owned and lived in by an applicant or recipient is an exempt asset. DHS 103.06(4)(b)(b) Net proceeds from the sale of homestead property shall be treated as assets as follows: DHS 103.06(4)(b)1.1. For AFDC-related MA the proceeds are considered available assets in the month of receipt and, if retained, in any of the following months; and DHS 103.06(4)(b)2.2. For SSI-related MA the proceeds are disregarded if they are placed in an escrow account and used to purchase another home within 3 months. After 3 months the proceeds are considered available. DHS 103.06(5)(a)(a) If the equity value of the non-homestead property together with all other assets does not exceed the asset limit, the person may retain the property and be eligible for MA. DHS 103.06(5)(b)(b) If the value of non-homestead property together with the value of the other assets exceeds the asset limit, the non-homestead property need not be counted as an asset if it produces a reasonable amount of income. In this paragraph, “reasonable amount of income”means a fair return considering the value and marketability of the property. DHS 103.06(5)(c)(c) If the total value of non-homestead property and non-exempt assets exceeds the asset limit, the person who owns the non-homestead property shall list the property for sale with a licensed realtor at a price which the realtor certifies as appropriate. If the property is listed for sale, it may not be counted as an asset. When the property is sold, the net proceeds shall be counted as an asset. DHS 103.06(6)(6) Life estate. The applicant or recipient may hold a life estate without affecting eligibility for MA. If the property or the life estate is sold, any proceeds received by the applicant or recipient shall be considered assets. In this subsection, “life estate” means a claim or interest a person has in a homestead or other property, the duration of the interest being limited to the life of the party holding it with that party being entitled to the use of the property including the income from the property in his or her lifetime. DHS 103.06(7)(a)(a) Trust funds shall be considered available assets, except that: DHS 103.06(7)(a)1.1. Trust funds payable to a beneficiary only upon order of a court shall not be considered available assets if the trustee or other person interested in the trust first applied to the court for an order allowing use of part or all of the trust fund to meet the needs of the beneficiary and the court denied such application; DHS 103.06(7)(a)2.2. Trust funds held in a trust which meets the requirements of ss. 701.0501 and 701.0502, Stats., shall not be considered available assets unless the settlor is legally obligated to support the beneficiary; DHS 103.06(7)(a)3.3. For SSI-related MA applicants and recipients, the pertinent SSI standards on the treatment of trusts as resources shall apply; and DHS 103.06(7)(a)4.4. For AFDC-related applicants and recipients, the pertinent AFDC standards on the treatment of trusts as resources shall apply. DHS 103.06(8)(8) Personal property. Household and personal effects of reasonable value, considering the number of members in the fiscal test group, shall be exempt. DHS 103.06(9)(9) Loans. Money received on loan shall be exempt unless it is available for current living expenses, in which case the money shall be treated as an asset even if a repayment schedule exists. DHS 103.06(10)(10) Life insurance policies. The cash value of a life insurance policy shall be considered an asset, except that for SSI-related persons it is an asset only when the total face value of all policies owned by the person exceeds $1,500. In this subsection, “cash value” means the net amount of cash for which the policy could be surrendered after deducting any loans or liens against it, and“face value” means the dollar amount of the policy which is payable on death. DHS 103.06(11)(11) Lump sum payments. All lump sum payments, unless specifically exempted by federal statute or regulation, shall be treated as assets instead of income. In this subsection, “lump sum payment”means a nonrecurring payment such as retroactive social security benefits, income tax refunds, and retroactive unemployment benefits. DHS 103.06(12)(12) Work-related items. Work-related items essential to the employment or self-employment of a household member, except motor vehicles, are exempt from being counted as assets. For business or farm operations, internal revenue service (IRS) returns shall be used to determine whether or not the operation is profitable or moving toward becoming profitable. If the operation is not profitable or becoming profitable, all assets related to the operation shall be counted in the determination of eligibility. DHS 103.06(13)(13) Special exempt assets for blind or disabled persons. The following assets shall be exempted in determining the eligibility of blind or disabled persons: DHS 103.06(13)(a)(a) Assets essential to the continuing operation of the person’s trade or business; DHS 103.06(13)(c)(c) Funds conserved for a departmentally approved plan for self-support of a blind or disabled person. The conserved funds shall be segregated from other funds. Interest earned on conserved funds is exempt so long as the conserved funds do not exceed the provision of the approved plan.
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administrativecode
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Department of Health Services (DHS)
Chs. DHS 101-109; Medical Assistance
administrativecode/DHS 103.06(1)(b)
administrativecode/DHS 103.06(1)(b)
section
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