State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

18-01 Version of 9.11 Processing Timeframe

9.11.1 Verification Receipt Date

The verification receipt date is the day verification is delivered to the appropriate IMincome maintenance agency or the next business day if verification is delivered after the agency's regularly scheduled business hours.

IM agencies must stamp the receipt date on each piece of verification received.

9.11.2 Positive Actions

Begin or continue benefits when:

1. The member provides requested verification within the specified time limits and is otherwise eligible. 
2. Requested verification is mandatory, but the member does not have the power to produce the verification and they are otherwise eligible. In this situation, the agency must also make an effort to obtain the verification (see Section 9.8 General Rules).

9.11.3 Delay

Notify an applicant when the agency is not able to process the application within 30 days for any reason. The Notice of Decision needs to provide the reason for the delay when all of the following conditions apply:

• Verification is needed.
• The applicant has the power to produce the verification. 
• The minimum time period allowed for producing the verification has not passed. 
•  Additional time is needed to produce the verification. 

CARESThis system supports the Income Maintenance operations for DHS and DCF. CARES is used to determine eligibility, issue benefits, track premium payments, and manage support for BadgerCare Plus, EBD Medicaid, W-2, Child Care, and Work Programs. will generate a notice to the applicant indicating the reason for the delay. If the reason is that verification is needed, the notice will indicate the specific verification or information required and the date the verification or information is due.

9.11.4 Negative Actions

Deny or reduce benefits when all of the following are true:

• The applicant or member has the power to produce the verification. 
• The time allowed to produce the verification has passed. 
• The applicant or member has been given adequate notice of the verification required. 
• You need the requested verification to determine current eligibility. Do not deny current eligibility because an applicant or member does not verify some past circumstance not affecting current eligibility. 

Note

Do not deny or terminate eligibility for failure to verify information that the member is not responsible to obtain, such as employer-sponsored health insurance (see Section 9.9.7 Access to Employer-Sponsored Health Insurance), Child Welfare parent cooperation (see Section 10.1 Child Welfare Parent or Caretaker Relative), and former Foster Care status (see Section 11.2 Former Foster Care Youth). Do not deny or terminate eligibility for failure to verify medical expenses (see Section 9.9.4 Medical Expenses) and deductions (see Section 9.9.8 Pretax Deductions and Section 9.9.9 MAGI Tax Deductions). The disallowance of unverified expenses and deductions is the only penalty to be imposed. Do not deny or terminate eligibility for failure to verify tribal member status (see Section 9.9.8 Tribal Membership, Descent, or Eligible to Receive Indian Health Services).

This page last updated in Release Number: 18-01
Release Date: 04/13/2018
Effective Date: 04/13/2018

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The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Publication Number: P-10171