Wis. Admin. Code Department of Health Services DHS 109.14 - SeniorCare benefit period
(1) DURATION.
Except as provided in subs. (3) to (5), and in s.
DHS
109.15 and s.
49.688(7) (a),
Stats., the benefit period for SeniorCare eligibility shall be 12 consecutive
calendar months.
(2) ELIGIBILITY
BEGIN DATE. Except as provided in sub. (3), a person's SeniorCare eligibility
begins on the first day of the month after the date the department receives a
complete application and the person meets all of the eligibility
requirements.
(3) EXCEPTION FOR
MEDICAID RECIPIENTS. If the department receives a complete application and
determines that the person meets all other eligibility requirements prior to
the date medical assistance eligibility ends, the person's SeniorCare
eligibility begins the day after the person's medical assistance eligibility
ends.
(4) TERMINATION OF SENIORCARE
BENEFIT PERIOD.
(a) Except as provided in
sub. (5), the department shall terminate the SeniorCare benefit period of a
SeniorCare participant who no longer meets the eligibility conditions in s.
DHS
109.11, or who requests a withdrawal from the program
under s.
DHS 109.11(5)
(d).
(b) The department shall restore the
SeniorCare benefit period for a person terminated from SeniorCare without a
break in coverage if, within one calendar month of the effective termination
date, he or she does both of the following:
1. Meets all of the eligibility criteria
under s.
DHS
109.11.
2.
Notifies the department of the change in circumstances.
(c) The department shall reinstate the
SeniorCare benefit period for a person who has requested a withdrawal from the
program under s.
DHS 109.11(5)
(d) if within 30 calendar days of the
effective date of the withdrawal both of the following occur:
1. The department receives the person's
request to have SeniorCare benefits restored.
2. The person meets all of the eligibility
criteria under s.
DHS
109.11, including a new payment of the program
enrollment fee specified in s.
DHS
109.16 for persons who were issued a refund under s.
DHS 109.11(5) (d)
1.
(5) CONTINUATION OF BENEFIT PERIOD FOR
MEDICAL ASSISTANCE RECIPIENTS. The department may not terminate the benefit
period of SeniorCare participants who lose eligibility solely due to receipt of
medical assistance benefits. A SeniorCare participant is not eligible for any
SeniorCare benefits or services under s.
DHS
109.13 for any calendar months in which he or she
receives medical assistance benefits.
(6) REQUEST FOR NEW BENEFIT PERIOD. A
SeniorCare participant may request a new benefit period for SeniorCare at any
time. Upon receipt of a new application, the department shall determine the
participant's eligibility for a new benefit period in the following manner
unless the application is from the spouse of a participant and meets the
conditions under s.
DHS
109.15:
(a) The
person shall submit a new application as required under s.
DHS
109.11.
(b) The department shall redetermine
eligibility when the request for a new benefit period is made beginning with
the date a new complete application is received.
(c) The department shall redetermine annual
income for a 12-month period beginning with the date a new complete application
is received.
(d) The department
shall redetermine which benefits and services under s.
DHS
109.13 the applicant may receive.
(e) The participant may withdraw the request
for a new benefit period as allowed under s.
DHS
109.11(5).
(f) Eligibility for the new benefit period
shall begin on the first day of the month after the date a new complete
application is received and all the eligibility requirements are met, including
payment of a new enrollment fee specified in s.
DHS
109.16.
(g) Prescription drug costs that had been
applied to a spend-down or deductible in a previous benefit period may not
apply to the new benefit period.
(h) Notwithstanding s.
DHS
109.15, if a person eligible for SeniorCare requests a
new benefit period at the same time the person's spouse applies for SeniorCare
or requests a new benefit period, eligibility shall be determined under this
section.
(i) The department shall
terminate a participant's current benefit period once the department determines
eligibility for a request for a new benefit period.
(7) ANNUAL ELIGIBILITY REVIEW. Eligibility
for a new benefit period determined under s.
DHS 109.11(6)
(b) shall begin on the first day of the month
immediately following the end of the previous benefit period when the
department receives a complete application and all the eligibility requirements
are met, including payment of a new enrollment fee specified in s.
DHS
109.16, prior to the end of the 12th month of the
previous benefit period.
Notes
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