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State of Wisconsin |
Release 25-04 |
The member must report within ten days all changes to income, household composition, allowable deductions, including medical and remedial expenses that were once out of pocket but are covered once the applicant is a MAPP member, and other non-financial changes, including loss of employment, which affect eligibility. When a change in circumstance is reported, current health care benefits must be maintained while eligibility is being redetermined.
| Example 1 | Nancy does not have health insurance and currently pays $550 a month for a variety of medical/remedial expenses. She applies for MAPP and is found eligible as of December 1. Once she is eligible, MAPP will cover some of her medical/remedial expenses and reduce her out of pocket medical/remedial expenses down to $50 a month in December. Because Nancy must wait until the end of December to determine the final decrease in her monthly out of pocket expenses, she must report this decrease no later than January 10th. |
Following a change, if it is determined a member has a new or increased premium, implement the premium change as of the following effective date:
The effective date of a change that results in a reduced premium or no premium is the month of change or the month of report, whichever is later. Premium decreases must be reviewed, and eligibility redetermined when applicable, when coverage was maintained following a reported change or a timely renewal. Once eligibility is able to be redetermined, premium amounts for months with coverage maintained may need to be reduced or refunded. See Section 26.5.4.3 Excess Payments, PH 25.3.4 Change Processing, and PH 25.4.4 Changes in Premiums and Refunds.
This page last updated in Release Number: 25-04
Release Date: 12/10/2025
Effective Date: 12/10/2025
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