5.2 Medical Support / CSA Cooperation

5.2.1 Introduction
5.2.2 Failure to Cooperate

5.2.1 Introduction

Unless the person is exempt or has good cause for refusal to cooperate (see 5.3), each applicant /member that is referred, must, as a condition of eligibility, cooperate in:

Establishing the paternity of any child born out of wedlock for whom BadgerCare Plus is requested or received, and

Obtaining medical support for the applicant and for any child for whom BadgerCare Plus is requested or received.

Cooperation includes any relevant and necessary action to achieve the above. As a part of cooperation, the applicant may be required to:

Provide verbal or written information known to, possessed by, or reasonably obtainable by the applicant.

Appear as a witness at judicial or other hearings or proceedings.
Provide information, or attest to the lack of information, under penalty of perjury.
Pay to the CSA any court ordered medical support payments received directly from the absent parent after support has been assigned.
Attend office appointments as well as hearings and scheduled genetic tests.

Note: The applicant or member is only required to cooperate if the child under their care is eligible for benefits funded under Title 19 or is eligible for the Medicaid expansion category of the Children’s Health Insurance Program (CHIP). If the child’s BadgerCare Plus benefit is funded through any other source such as Title 21 Separate CHIP or GPR (i.e., state funds) the caretaker relative is not required to cooperate and can not be sanctioned for non cooperation. Check the Medical Status codes (See 51.1) to determine funding source. The CSA will monitor the child’s BadgerCare Plus funding source.

5.2.2 Failure to Cooperate

The CSA determines if there is non-cooperation for individuals required to cooperate. The IM agency determines if good cause exists (see 5.3). If there is a dispute, the CSA makes the final determination of cooperation. The member remains ineligible until he or she cooperates, establishes good cause, or cooperation is no longer required. The following individuals are not sanctioned for non cooperation:

Pregnant women,
Minors, and
Parents or caretaker relatives while the family is in a BadgerCare Plus Extension.

For a pregnant woman, failure to cooperate cannot be determined prior to the end of the month in which the 60th day after the termination of pregnancy occurs. Note: If the local CS agency determines that a parent is not cooperating because court ordered birth costs are not paid, the parent or caretaker is not sanctioned.

Example: Mary, a disabled parent, is applying for BadgerCare Plus for her and her son, Michael. She refuses to cooperate in obtaining medical support for Michael. Mary meets all other non-financial and financial criteria for BadgerCare Plus and EBD Medicaid. Mary is not eligible for EBD Medicaid or BadgerCare Plus, because she will not cooperate in obtaining medical support for Michael. Even though Mary has not cooperated in obtaining medical support for Michael, he remains eligible for BadgerCare Plus.

This page last updated in Release Number: 13-02

Release Date: 10/25/13

Effective Date: 10/01/13