Wis. Admin. Code Department of Health Services DHS 102.03 - Verification of information

(1) An agency that has complied with subs. (1g) and (1r) shall deny an application for MA when the applicant or recipient is able to produce required verifications but refuses or fails to do so, except that a refusal or failure by an applicant for MA to verify assets does not affect eligibility for BadgerCare Plus under s. 49.471, Stats. If the applicant or recipient is not able to produce verifications, or requires assistance to do so, the agency may not deny assistance but shall proceed immediately to verify the data elements.

(1g) An individual shall not be required to provide additional information or documentation if it is not required to determine eligibility for the type of Medicaid or BadgerCare Plus, under subch. IV of ch. 49, Stats., that the member is requesting.

(1r) An individual shall not be required to provide additional information of documentation unless information needed by the agency cannot be obtained electronically or the information obtained electronically is not reasonably compatible with information by or on behalf of the individual. Income information obtained through an electronic data match shall be considered reasonably compatible with income information provided by or on behalf of an individual if both are at or below the applicable standard for MA.

(2) The agency shall verify those data elements deemed appropriate under the circumstances of the case history for an applicant who has been convicted of public assistance-related fraud, is repaying aid pursuant to an agreement with the district attorney's office, or is known to have provided erroneous information on a previous application which resulted in an incorrect issuance of assistance.

(3) Each of the following items shall be verified when applicable:

(a) Income.

(b) Pregnancy, when the agency has information that contradicts the member's self-attestation. If there is no contradictory information, the agency shall accept the member's self-attestation of pregnancy.

(d) Social security number, subject to all of the following requirements:

1. Services must not be denied or delayed to an otherwise eligible individual pending issuance or verification of the individual's social security number by the Social Security Administration.

2. Any of the following individuals are not required to provide a social security number:

a. Individuals who are deemed eligible for MA, based on being born to a pregnant woman eligible for MA in Wisconsin, until they turn 1 year of age.

b. Individuals who are not eligible to receive a social security number.

c. Individuals who do not have a social security number and may only be issued a social security number for a valid non-work reason in accordance with 20 CFR 422.104.

d. Individuals who refuse to obtain a social security number because of well-established religious objections, as provided in s. 49.82 (2) (b)3, Stats.

(e) Age.

(f) Citizenship subject to s. DHS 102.035.

(g) Disability, blindness, or both.

(h) Assets.

(i) Residence.

(j) Immigration status, subject to s. DHS 102.036.

Notes

Wis. Admin. Code Department of Health Services DHS 102.03

Cr. Register, February, 1986, No. 362, eff. 3-1-86; emerg. am. (1), eff. 7-1-99; am. (1), Register, March, 2000, No. 531, eff. 4-1-00; corrections in (3) (b) and (c) made under s. 13.92(4) (b) 7, Stats., Register December 2008 No. 636. Amended by, CR 21-067: cr. (4) Register March 2022 No 795, eff. 4-1-22, r. (4) 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 (4) made under s. 35.17, Stats., Register March 2022 No. 795, eff. 4/1/2022 Amended by, CR 23-046: am. (1), cr. (1g), (1r), am. (3) (intro.), (a), (b), r. (3) (c), renum. (3) (d) to (3) (d) (intro.) and am., cr. (3) (d) 1., 2., am. (3) (e) to (h), cr. (3) (j) Register April 2024 No. 820, eff. 5-1-24; correction in (3) made under s. 13.92 (4) (b) 7, Stats., and correction in (1g) made under s. 35.17, Stats., Register April 29 No. 820, eff. 5/1/2024

Sub. (4) is repealed by CR 21-067 effective 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.