State of Wisconsin Department of Health Services

HISTORY

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

22-01 Version of 25.7 Timeframes

25.7.1 Time Frames Introduction

All applications received by an agency must be processed and eligibility approved or denied as soon as possible but no later than 30 calendar days from the date the agency receives the application. For paper applications, this is the date a signed valid application is delivered to the agency or the next business day if it is delivered after the agency’s regularly scheduled business hours. For phone applications, this is the date a valid signature is received by the agency. For electronic applications from ACCESS or the Marketplace, this is the next business day if the application is delivered after 4:30 p.m., on a weekend, or on a holiday.  

This includes issuing a notice of decision.

IM workers should not delay eligibility for an individual in a household when waiting for another household member's citizenship or identity verification. The individual pending for citizenship/identity should be counted as part of the group when determining eligibility for other group members (see Section 2.2 Coverage Group Definitions).

Extend the 30-day processing time up to an additional 10 days, if you are waiting for the applicantA request for BadgerCare Plus coverage. The request must be on the Department's or Federally-facilitated Marketplace’s application, registration form or account transfer (from Federally-facilitated Marketplace) and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. to provide additional information. 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 issue a pending notice indicating the reason for the delay when appropriate entries are made on the Verification Due Page.

Deny 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. for failure to provide information or verification, if:

1. Requested information or verification is required by program policy to determine eligibility (see Chapter 9 Verification), and
2. The applicant had the power to produce the information or verification, within the period, but failed to do so, and
3. The applicant had a minimum of 10 days to produce the verification.  

Example 1

A signed application was received on March 15. The worker processed the application on April 7 and requested verification. Verification was due April 17 but was not received by that date. Even though the end of the 30-day application processing period was April 13, the application should not have been denied until April 18 to allow at least 10 days to provide verification.

If the agency fails to take action (positive or negative) during the 30-day processing period, and the applicant is subsequently found eligible, determine eligibility using the original filing date.

Example 2

A signed application was received on May 15. The first day of the 30-day period was May 16. The end of the 30-day period would have been June 14. The application was approved on June 20, and the applicant is determined eligible beginning May 1.

 

Example 3

A signed application was submitted to the Marketplace on March 2. The Marketplace assessed the individual as potentially eligible for BadgerCare Plus and transferred the individual’s account to the agency on March 5. The first day of the 30-day period for processing requirements was March 6. The end of the 30-day period would have been April 4. The application was approved on March 31, and the applicant is determined eligible beginning March 1.

25.7.2 Changes

Changes that occur between the filing date and the confirmation date should be used in the initial eligibility determination.

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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