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State of Wisconsin |
Release 26-01 |
KBM certification periods are 12 months, and eligibility is maintained under continuous coverage policies until the end of the KBM certification period.
When a timely KBM renewal is submitted, a member’s existing health care coverage must be maintained while their renewal is being processed. A timely renewal is one received during the renewal month, including renewals received after adverse action but by the last business day of the renewal month.
Members whose eligibility cannot be administratively renewed, and who do not submit their renewal by adverse action of the renewal month, will be notified that their coverage is ending at the end of the renewal month. They will be sent a notice of decision explaining that they are being disenrolled for failure to complete their renewal.
If the member’s renewal is received after adverse action but by the end of the renewal month, their current coverage will be reinstated and maintained until the renewal is processed. The member will be notified of the reinstatement.
At renewal, if the member still does not meet KBM requirements due the change in circumstance during their certification period they will be notified that they no longer qualify for KBM, and that additional information is needed to determine if they are eligible for a different form of Medicaid. The notice explains how to apply for health care with the IM agency and informs the member that, if their application is received by the due date (30 days from the date the notice was sent), they will keep their current coverage until the application is processed.
KBM coverage will be maintained for at least 30 days from the date the letter is sent to give the member time to apply. If the IM agency receives an application by the due date, KBM coverage will continue until the IM agency finishes processing the application. See Section 5.2.3 Katie Beckett Medicaid Members Moving to Other EBD Medicaid Programs, regarding disability transition when KBM coverage is ending.
If the IM agency does not receive an application by the due date, KBM coverage will end with timely notice. Applications received after the due date will be processed in accordance with normal application policies.
| Example 1 | Tina is 12 years old and enrolled in KBM. In March, her father reports that Tina is hospitalized and is expected to remain in the hospital for several months. While KBM requires members to be living in a home or community setting (rather than a medical institution), Tina remains enrolled in KBM for the remainder of her 12-month continuous coverage period, which ends in August. On August 3, the KBM worker processes Tina’s renewal. Tina is still living in a medical institution, and therefore no longer qualifies for KBM. On August 4, a letter is sent to the household informing them that Tina no longer qualifies for KBM, but if she applies for health care and the application is received by September 3, her current coverage will continue until the application is processed. Tina’s father applies by phone on August 10. On August 20, the IM worker determines Tina is eligible for Institutional Medicaid starting on October 1. Her KBM ends on September 30. |
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