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Wisconsin Department of Health and Family Services Obsolete Medicaid Eligibility Handbook For the current MEH, see http://www.emhandbooks.wi.gov/meh-ebd/ For the current BC Plus Handbook, see http://www.emhandbooks.wi.gov/bcplus/ |
The MA deductible period is a period of six consecutive months. It is the length of time the group ( fiscal or FFU) has for meeting the MA deductible. It begins in the month which the applicant chooses, and it ends six months later.
The applicant can choose to begin the MA deductible period as early as three months prior to the month of application, and as late as the month of application.
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Example 1: John applies for MA in July. He can choose to begin his six month MA deductible period in April, May, June, or July. |
The applicant cannot choose an MA deductible period which includes a month in which, if s/he had applied, s/he would have been ineligible due to excess assets.
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Example 2: Doyle applies for MA in July. He has excess income in July. He wants an MA deductible period that goes from April through September. In addition to having excess income in April, Doyle had $5,000 in his savings account on April 30. He cannot include April in his MA deductible period. He no longer had the $5,000 on May 31, so he can begin his MA deductible period in May. |
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Example 3: Clarice applies for MA in July. She has excess income in July. She wants an MA deductible period that goes from April through September.
In addition to having excess income in April and May, Clarice had an inheritance of $5,000 in May. She still retained it on May 31. Therefore, she cannot include May or any months prior to May in her MA deductible period. She no longer had the $5,000 on June 30, so she can begin her MA deductible period in June. |
The applicant can choose an MA deductible period which includes a month in which, if s/he had applied, s/he would have been ineligible for a non-financial reason. Although excess income is still calculated over a six month period, the individual can only be certified for MA during the dates when he or she was non-financially eligible.
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Example 4: Marion applies for MA in July. She has excess income in July. She wants an MA deductible period that goes from April through September.
Marion was incarcerated from April 30th through May 18th. She meets the deductible with a countable expense from April 10th, so she should be certified from April 10th through April 29th, and May 19th through September 30th. |
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Example 5: Janet applies for MA in July and requests an MA deductible period from April through September. She gave birth on June 30th. Janet paid the full deductible amount, so is certified from April 1st through June 30th. |
For backdate months, when a person had excess assets in any of the three months prior to the month of application, his/her eligibility in the backdate month is determined by whether or not s/he had excess assets on the last day of the month.
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Example 6: Jack applies for MA in July. He wants an MA deductible period that goes back two months to include May and June. In May, he would have been eligible except for excess income. In June he had received a $10,000 gift. On June 29 he went to the track and lost the $10,000. Had he applied on June 30 he would have been eligible. Jack can include both May and June in his MA deductible period. |
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Example 7: Mansour applies for MA in July. He is found to be eligible. He had medical bills in April and May. He also had excess income in April and May. He wants an MA deductible period that includes April and May. Unfortunately, he was the recipient of a $5,000 cash gift on June 29. It was several days before he was able to spend it on groceries and other legitimate purchases. Mansour will not be able to include April or May in the deductible period because on June 30, had he applied, he would have been determined ineligible. |
An individual can establish a new deductible period at any time if they file an application for Medicaid. This includes situations where someone has already established a deductible period, hasn’t yet met the deductible, and wishes to establish a new deductible period. This will usually occur as a result of a recent decrease in their monthly income.
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Example 8: Jeff applies for Medicaid on 1/1/04 and his monthly excess income is $100.00. His Medicaid deductible is $600.00 and his deductible period is January 01, 2004 through June 30, 2004. In April 2004, Jeff’s monthly excess income decreases to $10.00 a month. Jeff reports the decreased income in April and now has a choice between two different deductible recalculations. He can either have his worker recalculate the original $600.00 deductible which would then become a $330.00 deductible (three months of $100.00 excess income and three months of $10.00 excess income) or since he hasn’t yet met that deductible, he can file a new application in April and establish a new deductible period of April 2004 through September 30, 2004 with a $60.00 deductible obligation ($10.00 x 6 = $60.00). If Jeff hasn’t already incurred any substantial medical expenses, he may want to file a new application, set a new deductible period, and be in a better position to meet a much smaller deductible. (4.9.7.1) |
Individuals who have been certified for Medicaid after meeting a deductible, will have to complete a review to establish a new deductible period. CARES does not send a review notice to the client regarding the new deductible period if s/he did not meet the deductible for the current period.
This page last updated in Release Number : 07-07
Release Date: 08/30/07
Effective Date: 08/30/07