The last day of the month a change can be made in CARES to affect eligibility for the following month. Adverse Action is usually 13 days prior to the last day of the month to allow for a timely notice to be generated.
Applicant
A person who has submitted a request for enrollment in BC+ for whom no decision has been made regarding the person or group's eligibility for enrollment.
Application
A request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process.
Arrearages
Payments of child support which were due for a prior period.
Authorized Representative
A person authorized to act on a client's behalf for any of the Forward Health Programs. An authorized representative may be designated by the client and may exercise all the rights and responsibilities of a client.
Available Income
Income that is actually available or can be made available to the BC+ group for support and maintenance.
The primary person and any individuals living in his/her household whose income and/or needs are considered when determining financial eligibility. Inclusion in the Test Group is determined by qualifying relationships and legal responsibility.
BC+PP
BadgerCare Plus Prenatal Program
Client Assistance for Re-employment & Economic Support. `This system supports the Income Maintenance operations for DHFS and DWD. CARES is used to determine eligibility, issue benefits, track premium payments and manages support for BC+, EBD Medicaid, W-2, Child Care and Work Programs
Caretaker Relative
A caretaker who has a qualifying relationship to, but no legal responsibility for the child under 19 under his/her care.
Centers for Medicare and Medicaid Services (CMS)
Administers the Medicare program and works in partnership with the States to administer Medicaid and other programs. Formerly known as HCFA.
Certification Period
The period of time for which a member is eligible before the next renewal is due.
Child Welfare Parent/Caretaker
A parent or caretaker whose child has been temporarily removed from the home and is in the care of the child welfare system. To be eligible for enrollment in BC+ the Child Welfare Parent must be cooperating with a reunification plan.
COBRA Coverage
A provision of the Consolidated Omnibus Budget Reconciliation Act (COBRA) which requires employers to allow former employees to continue coverage through the employer's group plan for 18 months after the employment has ended (29 months if the employee is disabled). In most cases, the former employee must pay the full cost of COBRA coverage.
COLA
Cost of Living Adjustment. An increase in income to compensate for inflation
Conservator
A person, official, or institution designated to protect the interests of an incompetent person. A conservator has some, but not all, of the duties and powers of a legal guardian.
Cost-Share
An enrollee's financial responsibility for health care program coverage, such as a co-payment, premium or spenddown.
Custodial Parent
A parent who has physical custody of his or her minor child.
CWW
CARES Worker Web. The web based pages used in the CARES operations.
The amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan.
Depreciation
A federal income tax deduction for the cost of a business asset that gradually loses value through the wear and tear of use.
The date a member is eligible for coverage under the Forward Health Care Programs.
The filing date is the day a valid application/registration form is delivered to the appropriate Income Maintenance agency or the next business day if it is delivered after the agency's regularly scheduled business hours. The filing date on an ACCESS application is the date the application is electronically submitted or the next business day if submitted after 4:30 PM or on a weekend or holiday. The filing date sets the begin date of benefits.
Fiscal Agent
A private contractor to the State, selected through a competitive procurement process, who operates the State's approved MMIS (Medicaid Management Information System). The Fiscal Agent agreement includes claims processing and other services like data warehousing and manage care enrollment services. Wisconsin's current Fiscal Agent is HP Enterprise Services
FPOS
Family Planning Only Services - This program replaces the Family Planning Waiver (FPW) program in Wisconsin. This plan provides certain family planning services for people who are at least 15 years of age. The purpose of this plan is to stop unplanned pregnancies and sexually transmitted diseases (STDs).
The circumstances beyond a person's control which keep the person from following program requirements or specific eligibility conditions, such as premium payment or cooperation with medical support.
HIPAA is the Health Insurance Portability and Accountability Act. A HIPAA Standard Plan is any group health care plan that provides medical care to covered individuals and/or their dependents directly or through insurance, reimbursement, or by some other means. Medical care means amounts paid for diagnosis, cure, mitigation (moderation), treatment or prevention of disease; or amounts paid for the purpose of affecting any structure or function of the body. A policy that pays for a doctor's services in either an in-patient or outpatient setting qualifies as a HIPAA plan. The amount or type of benefits paid; co-insurance, deductibles, caps, etc., do not matter as long as the plan meets the HIPAA Standard Plan criteria. The health care plan cannot be limited to a single type of covered service or only accessible in a very defined circumstance. Plans limited to accident, disability, vision, long term care or dental are not examples of HIPAA plans.
HIPP
Health Insurance Premium Payment. HIPP pays the employee's portion of the employer subsidized health care coverage when the Fiscal Agent determines it is more cost effective to buy the employer's insurance or enroll them in BC or MAPP.
Institute for Mental Disease
Immigration Status
The legal status conferred on a non-citizen by immigration law
Kids Information & Data System
The local human services or Tribal office responsible for determining eligibility for Forward Health Care Programs.
Non-legally Responsible Relative (NLRR) Caretaker is a caretaker who has no legal responsibility for the child under his/her care. NLRR caretakers and their spouses can be eligible for BC+ as caretakers.
Non-qualifying immigrants
Non-qualifying immigrants are individuals that are not eligible for BC+ due to immigration status.
The form that includes the applicants name, address and telephone number. This form is used to set the filing date prior to submitting a completed application.
Per Member Per Month Cost of Care
The Captitation Amount paid by the State to the HMO for an individuals BC+ coverage.
A qualifying event allows an employee to enroll in the employer's health insurance plan outside the designated open enrollment period. Qualifying events include; obtaining a new dependent through marriage, birth, adoption or placement for adoption and loss of other insurance coverage the employee was covered under at the time of the last open enrollment period. The employee has 30 days from the qualifying event to enroll in the insurance. This applies to permanent employees who have a normal work week of thirty or more hours.
Restrictive Re-enrollment Period (RRP)
The period of time an individual is not eligible to enroll in BC+ due to non payment of a premium.
RRP
Restrictive Re-enrollment Period -The period of time an individual is not eligible to enroll in BC+ due to non payment of a premium.
Systematic Alien Verification for Entitlement. A process which allows access to USCIS data to validate the immigration status of immigrants who are applying, or for enrollees who report a change in immigration status, for BC+. Workers access the USCIS data through the Alien Status Verification System (ASVS).
SSN
Social Security Number
The obligation of a person or organization other than Medicaid or BC+ to pay for a person's medical expenses. Examples of TPL include group or private health insurance, auto insurance, worker's compensation, and personal liability insurance.
U.S. Citizenship and Immigration Services (USCIS
The federal agency responsible for immigration and citizenship. This agency was formerly known as the Bureau of Citizenship and Immigration Services (BCIS) and Immigration and Naturalization Service (INS).
Wisconsin Well Woman Program
Youths In or Exiting Out of Home Care. Young adults between the ages of 18 and 21 who were placed in Foster Care, court ordered Kinship Care or Subsidized Guardianship in Milwaukee County at the time they turned 18.