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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
Any parent or other caretaker relative who is required to cooperate in establishing paternity and obtaining medical support may claim good cause. They must do the following:
An applicant or member must receive a Good Cause Notice (DWSP 2018) whenever a child with an absent parent is part of the BadgerCare Plus application or case. The notice describes the right to refuse to cooperate for good cause in establishing paternity and securing medical support from the absent parent.
Applicants and members are not required to sign the Good Cause Notice in order to be eligible for BadgerCare Plus.
The Good Cause Claim form (DWSP 2019) must be provided to any BadgerCare Plus parent or caretaker who requests one. It describes the circumstances that support a claim and how to document a claim.
The parent or caretaker must sign and date the claim in the presence of an IM worker or a notary public. The applicant or member’s signature initiates the claim.
The original copy is filed in the case record, a copy is given to the parent or caretaker, and a copy is attached to the referral document when a claim is made at application.
A copy of claims must be sent to the CSA within two days after a claim is signed. When the CSA is informed of a claim, they will immediately suspend all activities to establish paternity or secure medical support until notified of your final determination.
The IM agency must determine whether or not cooperation is against the best interests of the child. Cooperation is waived only if one of the following is true:
An initial good cause claim may be based only on evidence in existence at the time of the claim. There is no limit to the age of the evidence. Once a final determination is made, including any fair hearing decision, any subsequent claim must be based on new evidence.
The following may be used as evidence:
When a claim is based on emotional harm to the child or the member, the IM agency must consider all of the following:
If the member submits only one piece of evidence or inclusive evidence, you may refer them to a mental health professional for a report relating to the claim.
When a claim is based on their undocumented statement that the child was conceived as a result of incest or sexual assault, it should be reviewed as one based on emotional harm.
The IM agency must conduct an investigation when a claim is based on anticipated physical harm and no evidence is submitted.
The member has 20 days, from the date the claim is signed, to submit evidence. The IM agency, with supervisory approval, may determine that more time is needed.
There must be at least one document of evidence, in addition to any sworn statements from the member.
The IM agency should encourage the provision of as many types of evidence as possible and offer any assistance necessary in obtaining necessary evidence.
When insufficient evidence has been submitted:
If the parent or caretaker continues to refuse to cooperate or the evidence is still insufficient, a 10-day notice must be sent informing the parent or caretaker that, if no further action is taken within 10 days from the notification date, good cause will not be found and that they may first:
If no option above has been taken when the 10 days have expired, the IM worker will deny BadgerCare Plus to the applicant or disenroll the member from BadgerCare Plus. The sanctions remain in effect until there is cooperation or until it is no longer required.
The IM agency must investigate all claims based on anticipated physical harm both when the claim is credible without corroborative evidence and when such evidence is not available.
Good cause must be granted when both the member's statement and the investigation satisfies the worker that they have good cause.
Any claim must be investigated when the member's statement, together with any corroborative evidence, does not provide a sufficient basis for a determination.
In the course of the investigation, neither the IM agency nor the CSA may contact the absent parent or alleged father without first notifying the member of the agency's intention. Once notified, the parent or caretaker has 10 days from the notification date to do one of the following:
If the 10 days have expired and no option has been taken, the IM agency will deny BadgerCare Plus to the applicant, and the sanctions shall remain in effect until there is cooperation or until it is no longer an issue.
The IM staff must determine whether or not there is good cause. This should be done within 45 days from the date a claim is signed. The time may be extended if it is documented in the case record that additional time is necessary because:
The good cause determination and all evidence submitted should be filed in the case record along with a statement on how the determination was reached.
If there is no evidence or verifiable information available that suggests otherwise, it must be concluded that an alleged refusal to cooperate was, in fact, a case of cooperation to the fullest extent possible.
If the parent or caretaker is cooperating in furnishing evidence and information, do not deny, delay, or discontinue BadgerCare Plus pending the determination.
If a fair hearing is requested on a good cause determination, BadgerCare Plus certification is continued until the decision is made.
The 45-day period for determining good cause is not used to extend an eligibility determination. The 30-day limit on processing an application is still a requirement.
The IM worker must notify the applicant or member in writing of the final determination and of the right to a fair hearing and send the CSA a copy. The CSA may also participate in any fair hearing.
When good cause is granted, the IM worker must direct the CSA to not initiate any or to suspend all further case activities.
However, when the CSA's activities, without the member's participation, are reasonably anticipated to not result in physical or emotional harm, the IM agency must:
The IM agency determination to proceed without the member's participation must be in writing. Include your findings and the basis for the determination. File it in the case record.
When good cause is not granted, the IM agency must notify the parent or caretaker. It must be stated in the notice that the parent or caretaker has 10 days from the notification date to do one of the following:
If the 10 days have expired, no option has been taken, and the member is in non-cooperation status, the IM agency must terminate the member’s BadgerCare Plus eligibility. Sanctions remain in effect until there is cooperation or it is no longer an issue. The IM agency will continue to refer the case to the CSA.
The IM agency does not have to review determinations based on permanent circumstances. Review good cause determinations that were based on circumstances subject to change at redetermination and when there is new evidence.
The parent or caretaker must be notified when it is determined that good cause no longer exists. It must be stated in the notice that they have 10 days from the notification date to do one of the following:
If the 10 days have expired and no option has been taken, the IM agency must deny the individual’s BadgerCare Plus eligibility. The sanctions remain in effect until there is cooperation or until it is no longer an issue.
This page last updated in Release Number: 22-01
Release Date: 04/04/2022
Effective Date: 04/04/2022
The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.
Publication Number: P-10171