DHS 10.31(6)(a)(a) Decision date for financial and non-financial eligibility. Except as provided in par. (b), as soon as practicable, but not later than 30 days from the date the agency receives a financial and non-financial eligibility application that includes at least the applicant’s name, address, unless the applicant is homeless, and signature, the agency shall determine the applicant’s financial and non-financial eligibility and cost sharing requirements for the family care benefit. If the applicant is the spouse of a family care member, the agency shall notify both spouses in accordance with the requirements of s. 49.455 (7), Stats.

DHS 10.31(6)(am)(am) Decision date for functional eligibility. Except as provided in par. (b), as soon as practicable, but not later than 30 days from the date the resource center receives verbal acceptance from the applicant to proceed with the functional screen, the resource center will determine the applicant’s functional eligibility for the family care benefit.

DHS 10.31(6)(b)(b) Notice. The agency shall notify the applicant in writing of its determination. If a delay in processing the financial and non-financial eligibility application or determining functional eligibility occurs because of a delay in securing necessary information, the agency shall notify the applicant that there is a delay in processing the application. Communications with the applicant, either orally or in writing, in the attempt to obtain the missing information shall serve as notice of the delay. If the delay is not resolved within 30 days following this notice to the applicant of the missing information, the agency shall notify the applicant in writing of the delay in completing the determination, specify the reason for the delay, and inform the applicant of their right to appeal the delay by requesting a fair hearing under s. DHS 10.55.

DHS 10.31(7)(7) Enrollment. The agency shall complete and transmit, as directed by the department, all enrollment forms and materials required to enroll persons who are eligible and who choose to enroll in a care management organization.

DHS 10.31(8)(8) Fraud. When the agency director or designee has reason to believe that an applicant or enrollee, or the representative of an applicant or enrollee, has committed fraud, the agency director or designee shall refer the case to the district attorney.

DHS 10.31 HistoryHistory: Cr. Register, October, 2000, No. 538, eff. 11-1-00; CR 04-040: am. (6) (a) Register November 2004 No. 587, eff. 12-1-04; EmR2121: emerg. am. (4) (b), eff. 8-5-21; CR 21-081: am. (4) (b) Register May 2022 No. 797, eff. 6-1-22, am. (4) (b) eff. upon the termination of the Appendix K: Emergency Preparedness and Response and COVID-19 Addendum to the 1915 (c) Family Care program waiver; CR 22-026: am. (4) (a), (b), (5), (6) (a), cr. (6) (am), am. (6) (b) Register May 2023 No. 809, eff. 6-1-23.

DHS 10.32(1)(a)(a) Age. The person is at least 18 years of age at the time of application.

DHS 10.32(1)(b)(b) Residency. The person is a resident of a county, family care district or service area of a tribe in which the family care benefit is available through a care management organization. This requirement does not apply to a person who is either of the following:

DHS 10.32(1)(b)1.1. An enrollee who was a resident of the county, family care district or tribal area when he or she enrolled in family care, but currently resides in a long-term care facility outside the service area of the CMO under a plan of care approved by the CMO.

DHS 10.32(1)(b)2.2. An applicant who, on the date that the family care benefit first became available in the county, was receiving services in a long-term care facility funded under any of the programs specified under s. DHS 10.33 (3) (c) administered by that county.

DHS 10.32(1)(c)(c) Family care target group. The person has a physical disability, is a frail elder, or has a developmental disability.

DHS 10.32(1)(d)(d) Functional eligibility. The person meets the functional eligibility conditions under s. DHS 10.33.

DHS 10.32(1)(e)(e) Financial eligibility. The person meets the financial eligibility conditions under s. DHS 10.34.

DHS 10.32(1)(f)(f) Cost sharing. The person pays any cost sharing obligations as required under s. DHS 10.34 (4).

DHS 10.32(1)(g)(g) Acceptance of medical assistance if eligible. If the person is eligible for medical assistance, he or she applies for and accepts the medical assistance.

DHS 10.32(1)(h)(h) Other non-financial conditions. The person meets the nonfinancial conditions of eligibility for medical assistance under s. DHS 103.03 (2) to (9).

DHS 10.32(1)(i)(i) Divestment. The person is not currently ineligible for the family care benefit, under the provisions of ss. 49.453 and 49.454 (2) (c) and (3) (b), Stats., and s. DHS 103.065 because he or she divested assets. The divestment provisions of ss. 49.453, 49.454 (2) (c) and (3) (b), Stats., and s. DHS 103.065 apply to all family care applicants and enrollees, regardless of whether they are eligible for medical assistance.

DHS 10.32(2)(2) Provision of necessary information. A client or person acting on behalf of a client shall provide full, correct and truthful information necessary to determine family care eligibility, entitlement status and cost sharing requirements, including the following:

DHS 10.32(2)(a)(a) A declaration of assets on a form prescribed by the department.

DHS 10.32(2)(b)(b) A declaration of income on a form prescribed by the department.

DHS 10.32(2)(c)(c) Information related to the person’s health and functional status, as required by the department.

DHS 10.32(3)(3) Reporting of changes required. An enrollee shall report to the county agency any change in circumstances that would affect his or her eligibility under this section, including income and asset changes that would affect cost sharing obligations, as specified under s. DHS 10.34 (3) (f).

DHS 10.32(4)(4) Review of eligibility. Enrollees’ eligibility for the family care benefit shall be re-determined annually or more often when a county agency has information indicating that a change has occurred in an enrollee’s circumstances that would affect his or her eligibility or cost sharing requirements.

DHS 10.32 HistoryHistory: Cr. Register, October, 2000, No. 538, eff. 11-1-00; CR 04-040: am. (1) (b) 2. and (c) Register November 2004 No. 587, eff. 12-1-04; corrections in (1) (h) and (i) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; EmR2121: emerg. r. (4), eff. 8-5-21; CR 21-081: am. (4) Register May 2022 No. 797, eff. 6-1-22, am. (4) eff. the first day of the month after the emergency period, as defined in section 1135 (g) (1) (b) of the Social Security Act, 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 May 2022 No. 797; CR 23-046: am. (1) (a) Register April 2024 No. 820, eff. 5-1-24.