State of Wisconsin Department of Health Services

HISTORY

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

25-04 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

Benefits will begin or continue when:

• The member has submitted a timely renewal which remains in progress over adverse action of the renewal month.  
• The member submitted a timely renewal after adverse action but by the last business day of the renewal month.  
• The member has a change in circumstance and verification is requested to determine eligibility for other forms of health care. 
• The member provides requested verification within the specified time limits and is otherwise eligible. 
• 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

Applicants must be notified of a processing delay when: 

• 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. 

A notice is sent to the applicant indicating the reason for the delay, the specific verification required, and the date the verification is due.

If eligibility is maintained following a timely renewal with pending verification, a notice is generated to explain health care benefits are maintained during the redetermination.

9.11.4 Negative Actions

Benefits will be denied or reduced when all of the following are true:

• The member has been tested for all categories of health care and is determined ineligible. 
• 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. 
• The requested verification is required to determine current eligibility. Current eligibility cannot be denied for lack of verification of a past circumstance that does not affect current eligibility. 
• The member is not a child in a continuous coverage period (see section 1.2 Continuous Coverage for Qualifying Children).
   

Note

Eligibility cannot be denied or terminated for failure to verify information that the member is not responsible to obtain, such as employer-sponsored health insurance (see Section 9.9.7 Verification of Employer-Sponsored Health Insurance), Child Welfare parent cooperation (see Section 10.1 Eligibility for Parent or Caretaker Relative of Child Removed from Home), and former Foster Care status (see Section 11.2 Former Foster Care Youth). Eligibility cannot be denied or terminated for failure to verify medical expenses (see Section 9.9.4 Medical Expenses) and deductions (see Section 9.9.9 Pretax Deductions and Section 9.9.10 MAGI Tax Deductions). The disallowance of unverified expenses and deductions is the only penalty to be imposed. Eligibility cannot be denied or terminated for failure to verify tribal member status (see Section 9.9.8 Tribal Membership, Descent, or Eligible to Receive Indian Health Services)

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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