32.3 Presumptive Eligibility for Adults

Note: Wisconsin’s presumptive eligibility programs are known by multiple terms: Express Enrollment, Temporary Enrollment, and Presumptive Eligibility. Express Enrollment (EE) is the online application in ACCESS for making PE determinations. Presumptive Eligibility (PE) is the determination of whether an applicant is eligible to temporarily enroll in BadgerCare Plus (BadgerCare Plus) or Family Planning Only Services (FPOS). Temporary Enrollment (TE) is when an applicant has been found eligible to temporarily enroll in BadgerCare Plus or FPOS. All such policy in this handbook will be collectively referred to as Presumptive Eligibility.

32.3.1 Eligible Adults for PE

Adults (parents, caretakers and childless adults) can be found presumptively eligible for BadgerCare Plus if they meet the following financial and non-financial criteria:

Has assistance group income at or below 100% of the FPL, and
Is one of the following:

U.S. Citizen,
Lawfully residing in the United States for at least 5 years,
Lawfully residing in the United States and a refugee or is seeking asylum,
From Cuba or Haiti and is lawfully residing in the United States, or
Lawfully residing in the United States under one of the eligible immigration statuses listed in section 4.3.4.

Adults will be limited to one PE period within a rolling 12-month period, starting with the effective date of the initial PE period. Qualified hospitals are required to assist applicants with the completion of the full BadgerCare Plus application.

Note: Please see the Medicaid Eligibility Handbook (MEH) Chapter 36.2.2.1 for information on PE under the Wisconsin Well Women Medicaid (WWMA) program for women under age 65 with breast or cervical cancer.

32.3.2 Qualified Entities

Qualified hospitals certified by ForwardHealth can make presumptive eligibility determinations for adults.

Qualified hospitals will be allowed to make PE determinations for patients who are inmates of public correctional institutions that are not state correctional facilities (e.g., county jails) as long as those patients are expected to remain in the hospital for 24 hours or more. The PE determination process for these patients will be the same as for other patients. Patients who are inmates of a state correctional facility are not eligible for Medicaid or BadgerCare Plus through the hospital PE process.

If an application is made for BadgerCare Plus at the local agency by the end of the month following the month in which the individual was determined presumptively eligible, the enrollment period ends the day on which the agency completes processing the BadgerCare Plus application, regardless of the result of the eligibility determination.

If a BadgerCare Plus application is not submitted by the end of the month following the month in which the individual was temporarily enrolled, the PE period ends the last day of the month following the month in which the individual was enrolled.

This page last updated in Release Number: 14-03

Release Date: 09/05/14

Effective Date:02/01/14