40.2 FPOS Presumptive Eligibility (PE)

40.2.1 Introduction 40.2.2 Qualified Entities 40.2.3 IM Agency 40.2.4 Express Enrollment Process in ACCESS

40.2.1 Introduction

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.

FPOS temporary enrollment through a PE determination provides family planning services beginning on the day that a qualified provider determines that the individual has income at 306% FPL, and is:

Of child bearing or reproductive age, and
A Wisconsin resident, and
Not enrolled in BadgerCare Plus or receiving full benefit Medicaid,
One of the following:

For individuals under 19:

U.S. Citizen, or
Lawfully present in the United States (no requirement for the amount of time the person is lawfully present in the U.S.).

For individuals age 19 and older:

U.S. Citizen;
Lawfully residing in the United Status under one of the eligible immigration statuses/situations listed in section 4.3.4.

For more information about income disregards under MAGI rules, see 16.1.2. The qualified entity should refer non-citizens to the Income Maintenance Agency (IM) for a BadgerCare Plus eligibility determination. FPOS PE extends from the date that an individual is determined eligible by the qualified provider through either:

The last day of the month following the month in which he or she was determined presumptively eligible, or

If the individual applies for FPOS by the end of the month following the month in which he or she was found presumptively eligible, the enrollment period ends the day on which the agency determines his or her eligibility.

FPOS PE can only be received once within a rolling 12-month period.

40.2.2 Qualified Entities

Qualified entities are certified ForwardHealth to make PE determinations. A qualified entity determines if an individual is eligible to temporarily enroll in FPOS. If the individual is eligible, the qualified entity will:

Complete and sign the Temporary Enrollment for FPOS form (F-10119). Beginning September 28, 2014, qualified entities will be able to make PE determinations for FPOS using the Express Enrollment process in ACCESS. See ACCESS Handbook Chapter 12.”

Complete the temporary ID card (F-10119) and give it to the member. The certification dates are from the date FPOS PE is determined through the end of the month following the month in which the determination is made.

Explain that the duration of a FPOS PE period depends on when the member applies for BadgerCare Plus and ongoing FPOS benefits through the local IM agency.

1. If the member applies for ongoing FPOS by the end of the month following the month in which he or she was determined eligible for FPOS PE, the ongoing FPOS period begins the first of the month in which the member applied and is found eligible. The FPOS PE period ends the day before the members ongoing FPOS period begins.

Example 1: Amber applied for FPOS PE on September 19th. She is temporarily enrolled through October 31st. Amber applied for ongoing FPOS on November 2nd and was found eligible. Amber’s ongoing FPOS begins November 1st, and ends October 31st of the following year. Amber did not request a three month backdate.

1. If the member does not apply by the end of the second month following the month in which he or she was determined eligible for FPOS PE, the FPOS PE period ends the last day of the second month following the month in which the member was determined eligible for FPOS PE.

Example 2: Brenda applied for FPOS PE on April 3, 2011. Her FPOS PE continues through May 31, 2011. Brenda does not apply for ongoing FPOS until August 15, 2011 and is found eligible. Brenda requests a backdate of the FPOS for three months and is found eligible. Her FPOS is backdated to May 1, 2011.

Send a copy of the completed F-10119 to the fiscal agent within five days of completion.

40.2.3 IM Agency

If an individual applies for ongoing FPOS at the IM agency on or before the last day of the FPOS PE period:

Verify the member is presumptively by checking ForwardHealth interChange for a medical status code of PF.

Consider the applicationA 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. filed if the member's name, address and signature are on the application.

If you are unable to finish processing the application, by the end of the FPOS PE period, submit an F-10110 to extend the FPOS PE period for an additional calendar month.

40.2.4 Express Enrollment Process in ACCESS

Refer to ACCESS Handbook Chapter 12 for more information on determining presumptive eligibility for BadgerCare Plus using the Express Enrollment process in ACCESS.

This page last updated in Release Number: 14-03

Release Date: 09/05/14

Effective Date: 10/01/14