DHS 103.03(1)(b)8.8. The person is at least 19, but under 21 years of age and resides in an intermediate care facility, skilled nursing facility, or inpatient psychiatric hospital and meets the conditions under s. 49.47 (4), 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 NoteNote: Copies of the disability determination form may be obtained from the county or tribal income maintenance agency.
DHS 103.03(1)(f)(f) BadgerCare Plus eligibility. To be non-financially eligible for BadgerCare Plus, a person shall meet all of the following conditions:
DHS 103.03(1)(f)1.1. The person meets one of the conditions in par. (b).
DHS 103.03(1)(f)2.2. Except as provided in subd. 5m., the person is a child age 1 through 5 with household income over 191% of the federal poverty line or age 6 through 18 with household income over 156% of the federal poverty line, and does not have health insurance coverage that meets both of the following criteria:
DHS 103.03(1)(f)2.a.a. The health insurance coverage is provided by an employer that pays 80% of the premium or coverage is provided under the state of Wisconsin employee health plan.
DHS 103.03(1)(f)2.b.b. The health insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.
DHS 103.03(1)(f)2m.2m. The person is an unborn child and the unborn child’s mother does not have health insurance coverage that covers services provided in a service area that is within a reasonable driving distance from the person’s residence.
DHS 103.03(1)(f)3.3. Except as provided in subd. 5m., the person is a child age 1 through 5 with household income over 191% of the federal poverty line or age 6 through 18 with household income over 156% of the federal poverty line, and the person does not have access to coverage under a group health insurance plan that meets all of the following criteria:
DHS 103.03(1)(f)3.a.a. The health insurance coverage is provided by an employer that pays 80% of the premium or coverage is available under the state of Wisconsin employee health plan.
DHS 103.03(1)(f)3.b.b. The health insurance coverage would begin within 3 calendar months following the BadgerCare Plus application filing date, the BadgerCare Plus annual renewal month, or the start date of the employment through which the child can access the health insurance coverage.
DHS 103.03(1)(f)3.c.c. The employer of the person’s parent, step-parent or other caretaker relative residing with the person, when the person is under 19 years of age.
DHS 103.03(1)(f)3.cm.cm. The health insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.
DHS 103.03(1)(f)3.d.d. The health insurance policy is through the child’s employer, the employer of the child’s spouse when the spouse is residing with the child, or the employer of the child’s parent, step-parent or other caretaker relative residing with the child.