View History

1.1 Introduction to Medicaid

1.1.1 Introduction

1.1.2 Subprograms of Medicaid

1.1.3 Financial Introduction

1.1.3.1 Assets

1.1.3.2 EBD Fiscal Group

1.1.3.3  Disabled Minors

1.1.3.4 Income

1.1.4 Health Care Choice

1.1.5 How to Apply

1.1.1 Introduction

'Medicaid’ is a state/federal program that provides health coverage for Wisconsin residents that are elderly, blind, or disabled (EBD) or receive Wisconsin Well Woman Medicaid. Medicaid is also known as Medical Assistance, MA, and Title 19.  

1.1.2 Subprograms of Medicaid

There are different subprograms of Medicaid:

 

A person may fit into one (or more) of the above subprograms based on non-financial factors.  A person is eligible if s/he meets all Medicaid non-financial and financial requirements.  Individuals who are not elderly, blind or disabled (EBD) may be eligible for BadgerCare+ (BC+).  See the BC+ Handbook for more information.

1.1.3 Financial Introduction

See 39.4 for EBD asset limits. See 25.7.2 for TB-Related asset limits. See 1.1.3.3

to determine Medicaid eligibility for disabled minors that fail BadgerCare Plus financial

tests.

1.1.3.1 Assets

Use the EBD Related Determination worksheet when doing manual eligibility determinations for non institutionalized EBD Medicaid applicants and recipients.  The EBD fiscal group’s assets must be within the appropriate categorically needy or medically needy asset limit before any member of that group can qualify for Medicaid.  EBD fiscal groups who have assets in excess of the appropriate EBD medically needy asset limit are ineligible for Medicaid.

1.1.3.2 EBD Fiscal Group

An EBD fiscal group includes the individual who is non financially eligible for Medicaid and anyone who lives with them, who is legally responsible for them.  Spouses who live together are in each other’s fiscal group.  This means that the income and assets of both spouses are counted when determining Medicaid eligibility for either or both spouses.  The fiscal group size for this situation/living arrangement is two.

 

There are some exceptions to this concept.  A blind or disabled minor living with their parents would be a one person fiscal group.  Special instructions for deeming parental income and assets to the disabled minor are described in 24.1 SSI Related Medicaid Introduction.

 

Another exception to the fiscal group policy involves SSI recipients.  If one spouse is applying for EBD Medicaid and the other spouse is an SSI recipient, the SSI recipient spouse is not included in the other spouse’s fiscal group.  For this situation you would again have a one person fiscal group when determining the Medicaid eligibility of the non-SSI spouse.

 

An individual living in a medical institution for 30 or more consecutive days would be a one person fiscal group.  If the institutionalized person is married, refer to 18.1 Spousal Impoverishment Introduction for special instructions regarding spousal impoverishment procedures.

1.1.3.3   Disabled Minors

A blind or disabled minor (or dependent 18 year old) can have their Medicaid eligibility determined according to special procedures when the disabled minor fails BadgerCare Plus eligibility test or when the parent chooses to decline BC+ for their child and have their child receive EBD Medicaid if eligible. See section 15.1.2 Special Financial Tests for Disabled Minors.

1.1.3.4 Income

See 39.4 EBD Assets and Income Tables for EBD income limits.  See 39.5 FPL Table for all other MA income limits.  Chapters for each type of MA explain how to determine the income that you compare to the income limits.  

 

See 39.4.2 EBD Deductions and Allowances for TB-Related income limits.

1.1.4 Health Care Choice

It is possible for individuals to qualify for both BC+ and Elderly, Blind and Disabled Medicaid (EBD MA).  In some circumstances, CARES will automatically enroll the individual in the program with the best benefit plan and lowest cost share. The individual has the right to request coverage under the program not chosen by CARES.   See table below.  The change is effective in the next possible payment following Adverse Action , unless the member requests the change be effective in the month the request to change the health plan was made.

 

When CARES is unable to make an automatic choice between BC+ and EBD MA, a notice requesting the individual to make a choice will be generated.  Once the member has made a choice the decision remains in effect until:

  1. The member requests a change, or

  2. The member’s benefit under the health plan of his or her choice ends. (This includes being placed into an unmet deductible assistance group.)

 

EBD Eligibility

BC+ Eligibility     

 System Choice

MS/NS/MAPP w/no premium

No premium

EBD

MS/NS/MAPP w/no premium

Premium

EBD

MS/NS/MAPP w/o premium

BC+ Deductible

EBD

MAPP w/premium

No premium

BC+

NS Deductible

No premium

BC+

MAPP w/premium

Standard Plan with Premium

The program with the lesser premium

MAPP w/premium

Benchmark Plan with Premium

 EBD

NS Deductible

Premium

Member Choice

MAPP Premium

Deductible

Member Choice

NS Deductible

Deductible

Member Choice

 

1.1.5 How to Apply

The following application options are available for anyone who is applying for EBD Medicaid:

  1. ACCESS online application at https:// access.wisconsin.gov/

  2. Face-to-Face Interview at the local county/tribal office

  3. Mail-In

  4. Telephone Interview

 

Click here to view the Directory of local county/tribal agencies in Wisconsin or call Member Services at (800) 362-3002.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This page last updated in Release Number: 11-01

Release Date: 04/04/11

Effective Date: 04/04/11