DHS 103.09
DHS 103.09 Termination of medical assistance. DHS 103.09(1)(1)
Final month coverage. When eligibility ends, except in the case of death of the recipient, the MA benefits shall continue until the end of the calendar month.
DHS 103.09(2)
(2)
Four-month continuation of eligibility. When an MA group becomes ineligible for AFDC due solely to excess income, is receiving child support payments and all of the excess income consists of child support collections, and has received an AFDC payment in at least 3 of the 6 months immediately preceding the month in which ineligibility begins, eligibility for MA shall continue for 4 months from the date that AFDC eligibility was terminated. The 6 months preceding the month in which ineligibility begins includes the month in which the MA group became ineligible for AFDC if the MA group was eligible for and received AFDC for that month.
DHS 103.09(3)(a)
(a) When an MA group becomes ineligible for AFDC due to loss of the earned income disregards under s.
49.19 (5) (a) 4. and
4m., or
(am), Stats., or to a change in the amount of earned income disregards under s.
49.19 (5) (a) 4. and
4m., or
(am), Stats., eligibility for MA shall continue for 12 months from the date that AFDC eligibility was terminated.
DHS 103.09(3)(b)
(b) When an MA group becomes ineligible for AFDC due to an increase in earned income or an increase in hours of employment or a combination of increased earned income and increased hours of employment, eligibility for MA shall continue for 12 months from the date that AFDC eligibility was terminated provided that at least one member of the MA group received AFDC for at least 3 of the 6 months immediately preceding the month in which AFDC was discontinued and at least one member of the MA group is continuously employed during that period.
DHS 103.09(3)(c)
(c) When an MA group becomes ineligible for AFDC due to an increase in earned income, or to a combination of an increase in earned income and in increase in child support payments, and has received an AFDC payment in at least 3 of the 6 months immediately preceding the month in which ineligibility begins, eligibility for MA shall continue for 12 months from the date that AFDC eligibility was terminated. The 6 months preceding the month in which ineligibility begins includes the month in which the MA group became ineligible for AFDC if the MA group was eligible for and received AFDC for that month.
DHS 103.09(4)
(4)
Timely notice. The agency shall give the recipient timely advance notice and explanation of the agency's intention to terminate MA. This notice shall be in writing and shall be mailed to the recipient at least 10 calendar days before the effective date of the proposed action. The notice shall clearly state what action the agency intends to take and the specific regulation supporting that action, and shall explain the right to appeal the proposed action and the circumstances under which MA is continued if a fair hearing is requested.
DHS 103.09 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; am. (3) (a), r. (2) (a), renum. (2) (b) to be (2) and am., r. and recr. (3) (b), cr. (3) (c),
Register, March, 1993, No. 447, eff. 4-1-93;
CR 21-067: am. (2), (3)
Register March 2022 No 795, eff. 4-1-22, am. (2), (3) eff. the first day of the month after the emergency period, as defined in
42 USC 1320b-5 (g) (1) (B) and declared in response to the COVID-19 pandemic, ends.
DHS 103.10
DHS 103.10 Redetermination of eligibility. The agency shall give the recipient timely advance notice of the date on which the recipient's eligibility will be redetermined. This notice shall be in writing and mailed to the recipient at least 15 calendar days but no more than 30 calendar days before the redetermination date. The requirement for timely advance notice of eligibility redetermination does not apply to spend-down cases in which the period of certification is less than 60 days.
DHS 103.10 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86.
DHS 103.11
DHS 103.11 Presumptive eligibility for pregnant women. DHS 103.11(1)(1)
Requirements. Pregnant women may be determined presumptively eligible for MA on the basis of verification of pregnancy and preliminary information about family income. That determination shall be made by providers designated by the department who are qualified in accordance with this section. A provider qualified to make determinations of presumptive eligibility shall meet the following requirements:
DHS 103.11(1)(b)3.
3. Clinic services furnished by or under the direction of a physician; and
DHS 103.11(1)(c)1.
1. The migrant health center or community health center programs under section 329 or 330 of the public health service act;
DHS 103.11(1)(c)3.
3. The special supplemental food program for women, infants and children under section 17 of the child nutrition act of 1966;
DHS 103.11(1)(c)4.
4. The commodity supplemental food program under D.4 (a) of the agriculture and consumer protection act of 1973; or
DHS 103.11 Note
Note: Although “prenatal" was used in the filed rule order, the department's medical assistance manual uses the term “perinatal".
DHS 103.11(1)(d)
(d) Have been determined by the department to be a qualified provider under this section.
DHS 103.11(2)(a)
(a) A qualified provider shall ascertain presumptive MA eligibility for a pregnant woman by:
DHS 103.11(2)(a)2.
2. Determining on the basis of preliminary information that the woman's family income meets the applicable income limits.
DHS 103.11(2)(b)
(b) The provider shall inform the woman, in writing, of the determination of presumptive eligibility and that she has 14 calendar days from the date of the determination to file an application for MA eligibility with the county department of social services.
DHS 103.11(2)(c)
(c) Within 5 working days following the date on which the determination was made, the provider shall in writing notify the department and the agency where the woman will apply for MA eligibility of the woman's presumptive eligibility.
DHS 103.11(2)(d)
(d) In the event that the provider determines that a woman is not presumptively eligible, the provider shall inform her that she may file an application for MA eligibility at the county department of social services.
DHS 103.11 History
History: Cr.
Register, February, 1988, No. 386, 3-1-88; correction in (1) (a) made under s.
13.92 (4) (b) 7., Stats.,
Register December 2008 No. 636.
