DHS 108.02(12)(d)1.1. A waiver applicant shall mail his or her application for a waiver in writing to the department within 45 days after the date the department mailed its claim or affidavit pursuant to s. 49.496 or 49.849, Stats., or its notice under par. (c), whichever is later. The application shall include the following information:

DHS 108.02(12)(d)1.a.a. The relationship of the waiver applicant to the decedent and copies of documents establishing that relationship; and

DHS 108.02(12)(d)1.b.b. The criterion under par. (b) 2. a., b., or c. which is the basis for the application and documentation supporting the waiver applicant’s position.

DHS 108.02(12)(d)2.2. The department shall review each application and issue a written decision within 90 days after the application was received by the department. The department shall consider all information received within 60 days following receipt of the application. The department’s decision shall be based on information received within that time-period. The department’s written decision shall include information regarding the waiver applicant’s right to a hearing under par. (e).

DHS 108.02(12)(e)1.1. If a waiver applicant wishes to contest the department’s decision denying a waiver, the waiver applicant shall serve the department with a request for a hearing within 45 days of the date the department’s decision was mailed. The hearing request shall be in writing and shall identify the basis for contesting the decision. The request shall be submitted to the department of administration’s division of hearings and appeals. The date on which the division of hearings and appeals receives the request shall be the date of service.

DHS 108.02 NoteNote: The mailing address of the division of hearings and appeals is P.O. Box 7875, Madison, Wisconsin 53707.

DHS 108.02(12)(e)2.2. If a waiver applicant wishes to introduce information at the hearing that he or she did not submit to the department under par. (d), the applicant shall provide the department with that information by mailing it to the department with a postmark of at least 7 working days prior to the hearing date.

DHS 108.02(12)(e)3.3. The issue for hearing shall be whether the department’s decision was correct based on the information submitted to the department by the waiver applicant within the time periods specified in par. (d) 2. and subd. 2. No other information may be considered by the hearing examiner unless the hearing examiner finds that the applicant did not timely provide the information to the department for good cause. The hearing decision shall be the final decision of the department. The hearing shall be held in accordance with the provisions of ch. 227, Stats.

DHS 108.02(12)(f)(f) Applicability. Heirs and beneficiaries may apply for a hardship waiver under this subsection from estate claims filed by the department pursuant to s. 49.496 or 49.849, Stats., in the estates of persons who die on or after April 1, 1995.

DHS 108.02(13)(a)(a) Authority. The department may purchase coverage under a group health insurance plan offered by the employer of a member of an eligible family if the department determines that purchasing that coverage would not be more costly than providing coverage under BadgerCare.

DHS 108.02(13)(b)1.1. The department may not buy in to a group health insurance plan when any member of a family has been covered by a group health insurance plan offered by the employer of a member of an eligible family in the 6 months prior to the buy-in decision.

DHS 108.02(13)(b)2.2. Children in a family are not eligible for buy-in to a group health insurance plan if the family had health care coverage through the employer of a member of the family for these children within the previous 6 months.

DHS 108.02(13)(b)3.3. The employer shall pay at least 60% of the cost of the premiums for the group health insurance plan, but not more than 80% of the cost, for the department to purchase coverage under a group health insurance plan.

DHS 108.02(13)(c)(c) Buy-in method. The department shall purchase coverage by making payment to one of the following:

DHS 108.02(13)(c)1.1. The employer of the recipient.

DHS 108.02(13)(c)2.2. The insurance company that provides the group health insurance plan offered by the employer.

DHS 108.02(13)(c)3.3. If it is not practical or feasible for the department to purchase coverage by making payment to those specified in subd. 1. or 2., and if requested by the employer or the insurance company offering the group health insurance plan, directly to the employee as reimbursement for premiums paid by the employee.

DHS 108.02(14)(a)(a) Authority. The department may purchase a group health plan offered by the employer of an eligible person or non-eligible family member if the department determines that purchasing that coverage and the associated administrative expense would not be more costly than providing the medical assistance coverage described under this chapter.

DHS 108.02(14)(b)1.1. The department shall pay on behalf of the recipient all deductibles, coinsurance and other cost sharing obligations under the group health plan that are for services covered under the state plan, except for the nominal cost sharing amounts otherwise permitted under section 1916 of the social security act that are the responsibility of the recipient.