State of Wisconsin
Department of Health Services

HISTORY

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

21-02 Version of 25.9 Denials and Terminations

25.9.1 Termination

During the calendar month after a member’s enrollment has been terminated for a reason other than not completing a renewal, BadgerCare Plus can be reopened without requiring a new application or a new signature. The certification period for the health care assistance group (AG) prior to termination will be reinstated. The person may need to provide verification if required to complete the eligibility determination.

If more than a calendar month has passed since a member’s enrollment was terminated, the person must file a new application or make a new request (if another health care AG is open on the case) to reopen their BadgerCare Plus.

Example 1

Leroy is enrolled in BadgerCare Plus with a renewal date of December 31. On September 3, he reports to his IM agency that he received a raise at work which requires verification to be provided. Leroy does not submit the required verification by the due date, so his eligibility for BadgerCare Plus will end as of September 30. On October 7, Leroy contacts his IM agency to request that his health care be re-opened, and he provides the required verification of his income. Since this is within the calendar month after his BadgerCare Plus was terminated, Leroy does not need to submit a new application or new signature. Leroy remains eligible for BadgerCare Plus and his BadgerCare Plus certification period is reinstated with a renewal date of December 31.

 

Example 2

Linda is enrolled in BadgerCare Plus and her husband Leo is enrolled in MAPP with a renewal date of January 31. On September 2, she reports to her IM agency that Leo received a gift from his aunt, which increased his assets to $16,000. Leo’s assets are over the MAPP program asset limit, so his MAPP ends as of September 30. On December 10, Linda contacts her IM agency to request that Leo’s health care be reopened, as he purchased a vehicle (which is their only vehicle) and is no longer over the MAPP asset limit. It has been more than a calendar month since his MAPP was terminated, but because Linda is open for BadgerCare Plus, they do not need to submit a new application or new signature. Leo’s eligibility for MAPP is reinstated and his MAPP certification period with a renewal date of January 31.

If a case is closed at renewal due to failure to complete the renewal or provide verification for that renewal, the person's case can be reopened for BadgerCare Plus without filing a new application if they provide the necessary information within three months of the renewal date (see Section 26.1.2 Three-Month Late Renewals).

25.9.2 Denial

If the person applied for health care and the IM agency denied the health care application 30 or fewer days ago, the person can re-request health care without submitting a new application or a new signature. The date of the new health care request is the new filing date.

Example 1

Keisha submitted an application for health care on August 15. The IM agency processed the application on September 8 and denied health care for Keisha. Keisha calls the IM agency on September 20 to re-request health care. The new filing date for health care is September 20. The IM agency cannot require Keisha to submit a new application or a new signature since it is within 30 days of the denial date of her application.

If the person applied for health care and the IM agency initially denied the health care application more than 30 days ago, the person must sign and submit a new application in order to re-request health care, regardless of the other non-health care programs the person is enrolled in.

Example 2

James applied for health care and FoodShare on September 13. The IM agency processed the application on September 20 and denied health care for James, but approved FoodShare. James calls the IM agency on October 25 to re-request health care. James must submit a new application for health care since it is more than 30 days since the denial date of his application.

The person may need to provide verification if required to complete the eligibility determination.

This page last updated in Release Number: 21-02
Release Date: 8/30/2021
Effective Date: 8/13/2021


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