State of Wisconsin Department of Health Services

Release 26-02 April 15, 2026

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33.15 SeniorCare Annual Eligibility Renewal

An annual eligibility review is required for each participant by the end of the current 12 month benefit period to prevent a gap in coverage.

Members are mailed a preprinted Renewal Application and instructions approximately six weeks prior to the end of their current benefit period. The Renewal Application is preprinted with the information currently on file for the member. Members are required to review the information for accuracy, make any necessary changes, answer any questions, and return the signed form with their enrollment fee.

Eligibility for a new benefit period begins on the first day of the month immediately following the end of the previous benefit period when:

1. A valid pre-printed Renewal Application or new application form (F-10076) is received by the end of the current benefit period, and
2. All eligibility requirements are met, including payment of the $30 annual enrollment fee per person.

Note:

For the definition of “valid,” see Section 3.2.2 Application Processing.

33.15.1  Maintaining SeniorCare Coverage During Regularly Scheduled Renewals

When a timely renewal is submitted, a SeniorCare member’s 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 on or before 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, in accordance with timely notice requirements. 

However, if the member’s renewal is received after adverse action but by the end of the renewal month during business hours, their current coverage will be reinstated for the following month and will be maintained until the renewal is processed. The member will be notified of the reinstatement.

Example 1

Anne and Horace are a married couple enrolled in SeniorCare. January is the last month of their certification period, and their renewal is due on January 12. They do not submit the renewal by the due date. On January 17, a notice is sent to inform them that their SeniorCare coverage will end January 31 because they did not complete their renewal. Their renewal is received on January 31 during business hours. Anne and Horace’s SeniorCare coverage is reinstated for the month of February, and they are sent a notice that they are enrolled in SeniorCare effective February 1 and will remain enrolled while their renewal is being processed. On February 9, EMCAPO finishes processing the renewal and Anne and Horace remain eligible for SeniorCare. A new 12-month certification period is established beginning on March 1.

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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