DHS 102.03(1)(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. DHS 102.03(1g)(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. DHS 102.03(1r)(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. DHS 102.03(2)(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. DHS 102.03(3)(3) Each of the following items shall be verified when applicable: DHS 102.03(3)(b)(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. DHS 102.03(3)(d)(d) Social security number, subject to all of the following requirements: DHS 102.03(3)(d)1.1. 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. DHS 102.03(3)(d)2.2. Any of the following individuals are not required to provide a social security number: DHS 102.03(3)(d)2.a.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. DHS 102.03(3)(d)2.c.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. DHS 102.03 HistoryHistory: 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; 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; 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 2024 No. 820. DHS 102.035DHS 102.035 Verification of United States citizenship. DHS 102.035(1)(1) The agency shall verify citizenship through a data match with the Social Security Administration. If citizenship cannot be verified through a data match with the Social Security Administration, the agency must verify citizenship through satisfactory documentary evidence as specified in s. 49.84 (6) (d), Stats., except that any of the following are exempt from the requirement to verify citizenship: DHS 102.035(1)(e)(e) Individuals who are or were deemed eligible for MA in Wisconsin on or after July 1, 2006, based on being born to a pregnant woman eligible for MA. DHS 102.035(2)(2) The agency shall not re-verify or require an individual to re-verify citizenship at a renewal of eligibility or upon a subsequent application following a break in coverage. DHS 102.035(3)(3) If citizenship cannot be promptly verified, a reasonable opportunity period of 95 days shall be provided to applicants during which efforts must continue to obtain verification or, if necessary, request documentation. Benefits may not be delayed, denied, reduced, or terminated during the reasonable opportunity period if the individual is otherwise eligible for MA. A reasonable opportunity period shall only be granted once for verification of an individual’s U.S. citizenship. DHS 102.035 HistoryHistory: CR 23-046: cr. Register April 2024 No. 820, eff. 5-1-24. DHS 102.036DHS 102.036 Verification of immigration status. DHS 102.036(1)(1) The agency shall verify immigration status of persons declaring a satisfactory immigration status either through the electronic service established by the U.S. department of health and human services, or the department of homeland security. DHS 102.036(2)(2) Persons applying for MA emergency services provided under 42 USC 1396b(v) or applying for an unborn child under s. 49.471, Stats. shall not be required to verify their immigration status. DHS 102.036(3)(3) If immigration status cannot be promptly verified, a reasonable opportunity period of 95 days shall be provided to applicants during which efforts must continue to obtain verification or, if necessary, request documentation. Benefits shall not be delayed, denied, reduced, or terminated during the reasonable opportunity period if the individual is otherwise eligible for MA. An additional reasonable opportunity period may be granted when a change in immigration status is reported. DHS 102.036(4)(4) Unless the individual reports a change in immigration status or information is received that indicates a potential change in the individual’s status, the agency shall not re-verify or require an individual to re-verify immigration status at a renewal of eligibility or upon a subsequent application following a break in coverage. DHS 102.036 HistoryHistory: CR 23-046: cr. Register April 2024 No. 820, eff. 5-1-24. DHS 102.04(1)(a)(a) As soon as possible but not later than 30 days from the date the agency receives a signed application completed to the best of the applicant’s ability, the agency shall determine the applicant’s eligibility for MA. DHS 102.04(1)(b)(b) If medical examination reports are needed to determine disability or blindness, the agency shall make the disability decision no later than 60 days from the date the agency receives the signed application. DHS 102.04(1)(c)(c) If a delay in processing the application occurs because of a delay in securing necessary information, the agency shall notify the applicant in writing of all of the following: DHS 102.04(2)(2) Notice of decision. The agency shall send timely and adequate notice to applicants and recipients to indicate that MA has been authorized or that it has been reduced, denied or terminated. In this subsection, “timely” means in accordance with 42 CFR 431.211, and “adequate notice” means a written notice that contains a statement of the action taken, the reasons for and specific regulations supporting the action, and an explanation of the individual’s right under s. 49.45 (5), Stats., to request a hearing and the circumstances under which benefits will be continued if a hearing is requested. DHS 102.04(3)(3) Review of eligibility. A recipient’s eligibility shall be redetermined in any of the following circumstances: DHS 102.04(3)(a)(a) When information previously obtained by the agency concerning anticipated changes in the individual’s situation indicates the need for redetermination. DHS 102.04(3)(b)(b) Promptly after a report is obtained which indicates a change in the individual’s circumstances that may affect eligibility. DHS 102.04(3)(d)(d) At least every 12 months for SSI-related persons and persons eligible for the medicaid purchase plan, in accordance with sub. (4), except that when a person is determined to be permanently blind or disabled the agency may consider their blindness or disability as continuing until it is determined that they are no longer blind or disabled. DHS 102.04(3)(e)(e) At any time the agency has a reasonable basis for believing that a recipient is no longer eligible for MA. DHS 102.04(5)(a)(a) A review of eligibility under sub. (3) (c) or (d) shall be conducted without requiring information from the individual if the agency is able to do so based on reliable information contained in the recipient’s case record or more current information available to the agency, including but not limited to information accessed through data bases accessed by the agency. DHS 102.04(5)(b)(b) If the agency is able to redetermine eligibility based on such information, the agency shall notify the recipient of all of the following: DHS 102.04(5)(b)2.2. The requirement that the recipient must inform the agency if any of the information contained in such notice is inaccurate, but that the recipient is not required to sign and return such notice if all information provided on such notice is accurate. DHS 102.04(5)(c)(c) If the agency cannot redetermine eligibility in accordance with par. (a), the agency shall do all of the following: DHS 102.04(5)(c)1.a.a. A renewal form containing information available to the agency that is needed to renew eligibility. DHS 102.04(5)(c)1.b.b. At least 30 days from the date of the renewal form to respond and provide any necessary information and to sign the renewal form. DHS 102.04(5)(c)1.c.c. Notice of the agency’s intended action concerning the renewal of eligibility. DHS 102.04(5)(c)3.3. Reconsider in a timely manner the eligibility of a person who is terminated for failure to submit the renewal form or necessary information, if the person subsequently submits the renewal form within 90 days after the date of termination without requiring a new application. DHS 102.04 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; emerg. am. (2) and (3) (c), eff. 7-1-99; am. (2) and (3) (c), Register, March, 2000, No. 531, eff. 4-1-00; am. (3) (d), Register, November, 2000, No. 539, eff. 12-1-00; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; 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; CR 23-046: r. and recr. (1), am. (3) (intro.), (a) to (d), cr. (5) Register April 2024 No. 820, eff. 5-1-24; renumbering of (5) (b) to (5) (c) made under s. 13.92 (4) (b) 7., Stats., and correction in (5) (c) made under s. 35.17, Stats., Register April 2024 No. 820. DHS 102.05DHS 102.05 Fraud. When the agency director or a designee has reason to believe that fraud has been committed by an applicant or recipient, or by the representative of an applicant or a recipient, the case shall be referred to the district attorney. DHS 102.05 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86.
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