Section DHS 102.01 - Application Application for medical assistance (MA) shall be made pursuant to s. 49.47 (3), Stats., for medically indigent persons, s. 49.46, Stats., for categorically needy persons s. 49.473, Stats., for women diagnosed with breast or cervical cancer or precancerous conditions, and s. 49.471, Stats., for persons under BadgerCare Plus, and this chapter. Applications shall be made and reviewed in accordance with the following provisions:
(1) RIGHT TO APPLY. Any person may apply for MA. The application shall be made via the department's internet website, over the telephone, by fax, on a paper form, or in person with the agency.(2) APPLICATIONS FROM OUTSIDE WISCONSIN. (a) Except as provided under par. (b), application for Wisconsin MA shall not be accepted for a person residing outside Wisconsin.(b) If a Wisconsin resident becomes ill or injured when absent from the state or is taken outside the state for medical treatment, application for Wisconsin MA for that person shall be made on a Wisconsin application form and witnessed by the public welfare agency in the other state in accordance with 42 CFR 435.403.(3) WHERE APPLICATION IS MADE. Application shall be made to the agency in the county in which the primary person resides. An individual residing in a nursing home is considered a resident of the county where the nursing home is located. However, an application for a person in a state facility - northern, central, or southern center for the developmentally disabled; Winnebago or Mendota mental health institute; or the University of Wisconsin hospitals - shall be received and processed by the agency in the county in which the person resided at the time he or she was admitted to the facility.(4) ACCESS TO INFORMATION. (a) Persons inquiring about or applying for MA shall be given all of the following information by the agency in electronic and paper formats, and orally as appropriate: 1. The MA eligibility requirements.2. All available MA services.3. The rights and responsibilities of MA applicants and members.(b) Information must be provided to applicants and members in plain language and in an accessible and timely manner.(c) Applicants and members must be informed of the availability of accessible information and language services and how to access language services or auxiliary aids. At minimum, the agency must provide non-English language taglines indicating the availability of language services.(d) For individuals who are limited English proficient, the agency must provide language services including oral interpretations and written translations at no cost to the individual.(e) For individuals with disabilities, the agency must provide auxiliary aids and services at no cost to the individual, in accordance with the Americans with Disabilities Act, 42 USC 12101 to 12213.(5) SPECIAL APPLICATION SITUATIONS. Under the following circumstances, the following special application procedures shall apply:(a) When a person 19 years of age or older is living in the household of the primary person but is not the primary person or the primary person's spouse, the agency shall determine the eligibility of that person and that person's spouse or child, if any, separately from the rest of the persons listed on the application.(b) When an unmarried man and woman reside together and have a minor child-in-common, the agency shall determine the eligibility of the man and woman together on one application if the man is the father of the child, which shall be determined as follows: 1. If both the woman and the man are available, the man shall be considered the father of the child if his name is on the birth record, if paternity has been established under ch. 767, Stats., or if a completed statement of paternity form has been signed by him and the mother and has been mailed or delivered to the agency.2. If only the man is in the home and the woman is not available to participate in the steps necessary to fulfill the requirements of subd. 1., the man shall be determined to be the father of the child if any of the following circumstances apply: a. His name is on the birth records.b. He provides the agency with an affidavit in which he states that he is the child's father and proves that he and the child's mother lived together at the time of conception.c. He files with the department a declaration of paternal interest under s. 48.025, Stats., and proves that he and the child's mother lived together at the time of conception.d. He provides the agency with a written statement in which he acknowledges his paternity and proves that he and the child's mother lived together at the time of conception.e. He submits to the agency a sworn statement describing in sufficient detail the circumstances upon which he bases his claim to be the child's father and the agency has no reason to doubt his credibility. Note: The statement of paternity form (F-05024 for English; F-050245 for Spanish) can be obtained from the Division of Public Health, P.O. Box 309, Madison, WI 53701.
(c) When a child or adult resides in a MA-certified skilled nursing facility, intermediate care facility, or inpatient psychiatric facility, or is hospitalized and is unable to live outside of the hospital, the agency may determine individually the eligibility of the child or adult.(d) When a foster child resides in a licensed foster home or a child resides in a group home, the agency shall consider the child as the primary person for purposes of application.(e) When a child is a parent or is pregnant, but not married and not under the care of a relative as specified in s. 49.19 (1) (a), Stats., the agency shall determine individually the eligibility of the child.(f) In cases where 3 generations reside together, the agency shall consider the first generation to be caring for both the second-generation and third-generation children.(g)1. When a completed application is received before the death of an applicant who dies before eligibility is determined, the agency shall process and take action on the application in the same manner as with any other application.2. An application on behalf of a deceased person may be made by an interested person who attests to the correctness of the eligibility information on behalf of the deceased.(6) PROVIDING CORRECT AND TRUTHFUL INFORMATION. The applicant, recipient, or person described in sub. (7) acting on behalf of the applicant or recipient is responsible for providing to the agency, the department or its delegated agent, full, correct and truthful information necessary for eligibility determination or redetermination and for disclosing assets which the agency determines may affect the applicant's or recipient's eligibility, including but not limited to health insurance policies or other health care plans and claims or courses of action against other parties on the part of the applicant or recipient. Changes in income, assets or other circumstances which may affect eligibility shall be reported to the agency within 10 days of the change.(7) SIGNING THE APPLICATION. (a) In this subsection, "community spouse" and "institutionalized spouse" have the meanings provided in s. DHS 103.075 (3) (a) and (e).(b) Each application submitted online, over the telephone, by fax, or on paper shall be signed by the applicant or the applicant's caretaker relative, legal guardian, authorized representative or, where the applicant is incompetent or incapacitated, by someone acting responsibly for the applicant.(c) When an institutionalized person who is applying for MA or an institutionalized recipient whose eligibility for MA is being redetermined has a community spouse, both the institutionalized spouse and his or her spouse, their authorized representatives or someone acting responsibly for the institutionalized spouse or his or her spouse shall sign the application. Failure of either spouse or that person's authorized representative or someone acting responsibly on behalf of either spouse to sign the application shall result in ineligibility for the institutionalized spouse under s. DHS 103.075. Except as provided under s. DHS 103.075 (5) (e), the agency shall proceed to determine eligibility for the institutionalized spouse under s. DHS 103.04(4).(d) The signatures of 2 witnesses are required when the application is signed with a mark.Wis. Admin. Code Department of Health Services DHS 102.01
Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. (7), Register, March, 1993, No. 447, eff. 4-1-93; emerg. am. (intro.) and cr. (5) (h), eff. 7-1-99; am. (intro.) and cr. (5) (h), Register, March, 2000, No. 531, eff. 4-1-00; correction in (7) made under s. 13.93(2m) (b) 7, Stats., Register February 2002 No. 554; corrections in (7) made under s. 13.92(4) (b) 7, Stats., Register December 2008 No. 636.Amended by, CR 23-046: am. (intro.), (1), r. and recr. (4), am. (5) (a), (b) (intro.), 1., 2. (intro.), a. to d., r. (5) (h), r. and recr. (7) Register April 29 No. 820, eff. 5/1/2024