State of Wisconsin Department of Health Services

HISTORY

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

18-02 Version of 2.3 Where To Apply

2.3.1 Where to Apply Introduction

The agency (county/tribe or consortium) of the applicant’s county of residence should process the individual’s application.

An individual who resides in a nursing home/hospital for 30 days or more is considered a resident of the county in which the nursing home/hospital is located.

The applicant’s county of residence at the time of admission must receive and process applications for persons living in these state institutions:

• Northern, Central, and Southern Centers.
• Winnebago and Mendota Mental Health Institutes.
• The University of Wisconsin Hospital.

When an applicant contacts the wrong consortium or tribal agency, redirect him or her to the consortium or tribal agency responsible for processing the application immediately. Anytime an application is received in the wrong consortium or tribal agency, it must be redirected to the agency responsible for processing that application no later than the next business day. A paper application must be date stamped before it is redirected. The filing date remains the date originally received by the wrong consortium or tribal agency.

2.3.2 Intercounty Placements

When a county 51.42 board, 51.437 board, human services department, or social services department places a person in a congregate care facility that is located in another county, the placing county remains responsible for determining and reviewing the applicant’s Medicaid eligibility. This does not include situations where a guardian or the memberA recipient of Medicaid; formerly referred to as a "client." elects to move the member to another county. 

A congregate care facility is a:

• Child care institution
• Group home
• Foster home.
• Nursing home
• AFHAdult Family Home
• CBRFcommunity-based residential facility. A place in which five or more unrelated adults live and where they receive care, treatment, or services, but not nursing care on any permanent basis, in addition to board and room
• Any other like facility

The placing county may request the assistance of the receiving county in completing applications for persons who are not enrolled in Medicaid and reviews for Medicaid members. The receiving county must then forward the information to the placing county. The placing county remains responsible for determining the applicant’s eligibility.

If the placing county requests assistance from the receiving county, the placing county must provide the other agency with:

• The applicant’s name, age, and SSNSocial Security number.
• The date of placement.
• The applicant’s current Medicaid status.
• The name and address of the congregate care facility in which the applicant has been placed.
• The name of the county and agency making the placement.

When there is a dispute about responsibility, the social or human services department of the receiving county may initiate referral to the Department of Health Services' Area Administration office for resolution. Pending a decision, the county where the person is physically present must process the application, any changes, and reviews.

2.3.3 Applications Outside Wisconsin

Generally, an application should not be taken for a resident of Wisconsin when he or she is living outside of Wisconsin. An exception is when a Wisconsin resident becomes ill or injured outside of the state or is taken out of the state for medical treatment. In this case, the application may be taken, using Wisconsin’s application forms (see Section 2.2 Application Types/Methods), by the public assistance agency in the other state. The forms should be forwarded to the IM agency in the other state. The Wisconsin IM agency determines eligibility when the forms are returned.

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The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030