Section DHS 103.09 - Termination of medical assistance(1) FINAL MONTH COVERAGE. When eligibility ends, except in the case of death of the recipient, the MA benefits shall continue until the end of the calendar month.(2) FOUR-MONTH CONTINUATION OF ELIGIBILITY. (a) When a parent, caretaker, or pregnant person eligible for BadgerCare Plus has an increase in MAGI-based countable monthly income under s. DHS 103.04 (7) (d) that exceeds 100% of the federal poverty line, BadgerCare Plus eligibility for the persons identified in par. (c) will continue for four months when the conditions in par. (b) are met. Eligibility shall be discontinued when the person is no longer a resident of Wisconsin.(b) To receive a four-month continuation of BadgerCare Plus eligibility, all of the following conditions must be met by the parent, caretaker or pregnant person: 1. The monthly income increase which caused the countable income to exceed 100% of the poverty line must be due solely to one of the following:a. Increased spousal support income.b. Increased spousal support income along with other unearned income.2. There has been no increase in earned income.3. The person receiving the spousal support is eligible for BadgerCare Plus with monthly income at or below 100% of the poverty line at the time the income increased to over 100% of the poverty line.4. The person must have been enrolled in BadgerCare Plus with monthly income that was at or below 100% of the poverty line for at least three of the six months immediately preceding the month in which the monthly income went above 100% of the poverty line.5. The person must otherwise meet the BadgerCare Plus eligibility criteria for persons with monthly income below 100% of the poverty line.(c) When a parent, caretaker, or pregnant person eligible for BadgerCare Plus meets the condition in par. (b), any of the following persons in the home, who otherwise meet the BadgerCare Plus eligibility criteria are eligible for BadgerCare Plus for four months past the month in which income exceeded 100% of the poverty line: 1. The parent, caretaker or pregnant person who received the spousal support.2. All children whose parent or caretaker relative qualify for four months of continued eligibility under this subsection is eligible for the same four months of continued eligibility, provided that they are eligible for BadgerCare Plus in the month prior to the increase in countable income and one of the following applies: a. The child is under age one, and the parent or caretaker had MAGI-based countable income at or below 306% of the poverty line and is not eligible under ss. 49.471 (4) (a) 2 or 2m, Stats.b. The child is age one through five and the parent or caretaker had MAGI-based countable income at or below 191% of the poverty line.c. The child is age six through 18 and the parent or caretaker had MAGI-based countable income at or below 156% of the poverty line.(3) TWELVE-MONTH CONTINUATION OF ELIGIBILITY. (b) When a parent or caretaker relative in a BadgerCare Plus group becomes ineligible due to an increase in earned income, eligibility for BadgerCare Plus shall continue for 12 months from the date that eligibility was terminated if all of the following conditions are satisfied: 1. At least one member of the BadgerCare Plus group received BadgerCare Plus for at least 3 of the 6 months immediately preceding the month in which BadgerCare Plus was discontinued.2. at least one member of the BadgerCare Plus group is continuously employed during that period(c) When a parent or caretaker relative in a BadgerCare Plus group becomes ineligible for BadgerCare Plus due to an increase in earned income, or to a combination of an increase in earned income and in increase in spousal support payments, and has received BadgerCare Plus in at least 3 of the 6 months immediately preceding the month in which ineligibility begins, eligibility for BadgerCare Plus shall continue for 12 months from the date that BadgerCare Plus eligibility was terminated. The 6 months preceding the month in which ineligibility begins includes the month in which the BadgerCare Plus group became ineligible for BadgerCare Plus if the group was eligible for and received BadgerCare Plus for that month.(4) TIMELY NOTICE. The agency shall give the recipient timely advance notice and explanation of the agency's intention to terminate MA. This notice shall be in writing and shall be mailed to the recipient at least 10 calendar days before the effective date of the proposed action. The notice shall clearly state what action the agency intends to take and the specific regulation supporting that action, and shall explain the right to appeal the proposed action and the circumstances under which MA is continued if a fair hearing is requested.Wis. Admin. Code Department of Health Services DHS 103.09
Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. (3) (a), r. (2) (a), renum. (2) (b) to be (2) and am., r. and recr. (3) (b), cr. (3) (c), Register, March, 1993, No. 447, eff. 4-1-93.Amended by, CR 21-067: am. (2), (3) Register March 2022 No 795, eff. 4-1-22, am. (2), (3) eff. the first day of the month after the emergency period, as defined in 42 USC 1320b-5(g) (1) (B) and declared in response to the COVID-19 pandemic, ends. correction in (2), (3) made under s. 35.17, Stats., Register March 2022 No. 795, eff. 4/1/2022Amended by, CR 23-046: r. and recr. (2), r. (3) (a), renum. (3) (b) to (3) (b) (intro.) and am., cr. (3) (b) 1., 2., am. (3) (c) Register April 2024 No. 820, eff. 5-1-24; corrections in (2) (a), (c) (intro.), 1., 2. a. made under s. 35.17, Stats., Register April 29 No. 820, eff. 5/1/2024