DHS 109.14(6)(b)(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.

DHS 109.14(6)(c)(c) The department shall redetermine annual income for a 12-month period beginning with the date a new complete application is received.

DHS 109.14(6)(f)(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.

DHS 109.14(6)(g)(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.

DHS 109.14(6)(h)(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.

DHS 109.14(6)(i)(i) The department shall terminate a participant’s current benefit period once the department determines eligibility for a request for a new benefit period.

DHS 109.14(7)(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.

DHS 109.15DHS 109.15 Treatment of spouses. Notwithstanding ss. DHS 109.13 and 109.14, when the spouse of a SeniorCare participant files an application or review of eligibility for SeniorCare under s. DHS 109.14 (7), or requests a new benefit period, and is required under s. DHS 109.12 (1) to be in the same fiscal test group as the participant, the eligibility of the spouse for benefits and services under s. DHS 109.13 and the duration of the spouse’s benefit period shall be determined in the following manner, unless both the participant and the participant’s spouse jointly file a request for a new benefit period under s. DHS 109.14:

DHS 109.15(1)(1) The department shall determine the eligibility of the spouse under s. DHS 109.11, and, if eligible for SeniorCare, determine the beginning eligibility date of the spouse’s benefit period according to s. DHS 109.14.

DHS 109.15(2)(2) If the department under sub. (1) determines the spouse is eligible for SeniorCare the spouse’s benefit period shall end on the same date as the participant’s benefit period ends.

DHS 109.15(3)(3) If the department determines the spouse is ineligible for SeniorCare, the benefits and services that the participant spouse may receive during the participant’s current benefit period may not be affected.

DHS 109.15(4)(4) If the income of the spouse was not used to determine the SeniorCare benefit for the participant spouse, both of the following apply:

DHS 109.15(4)(a)(a) The department shall determine the annual income for the fiscal test group for the 12-month period beginning with the month the application request for the spouse is received.

DHS 109.15(4)(b)1.a.a. If the annual income of the fiscal test group exceeds 240% of the poverty line for a 2-person family, the spouse may receive spend-down services under s. DHS 109.13 (4) (a) 2.

DHS 109.15(4)(b)1.b.b. When determining whether the spouse meets the SeniorCare spend-down under s. DHS 109.13 (4) (c), the amount of the SeniorCare spend-down shall be prorated. The prorated amount shall be the annual spend-down amount under s. DHS 109.13 (4) (b) multiplied by the number of months of the spouse’s benefit period derived from subs. (1) and (2), divided by 12. Only prescription drug costs of the spouse may count towards meeting the prorated spend-down.

DHS 109.15(4)(b)1.c.c. If the spouse meets the prorated spend-down during the benefit period, the spouse may receive the deductible benefit and services under s. DHS 109.13 (3) (b). When determining whether the spouse meets the SeniorCare deductible under s. DHS 109.13 (3) (c) and (d), the amount of the SeniorCare deductible shall be prorated. The prorated deductible amount shall be $850 multiplied by the number of months of the spouse’s benefit period derived from subs. (1) and (2), divided by 12.

DHS 109.15(4)(b)1.d.d. If the spouse meets the prorated deductible during the benefit period, the spouse may receive the prescription benefit under s. DHS 109.13 (2) (b).

DHS 109.15(4)(b)2.a.a. If the annual income of the fiscal test group is greater than 160%, but not in excess of 240% of the poverty line for a 2-person family, the spouse may receive the deductible benefit and services under s. DHS 109.13 (3) (b).

DHS 109.15(4)(b)2.b.b. When determining whether the spouse meets the SeniorCare deductible under s. DHS 109.13 (3) (c) and (d), the amount of the SeniorCare deductible shall be prorated. The prorated deductible amount shall be the dollar amount specified in s. DHS 109.13 (3) (c) multiplied by the number of months of the spouse’s benefit period derived from subs. (1) and (2), divided by 12.

DHS 109.15(4)(b)2.c.c. If the spouse meets the prorated deductible during the benefit period, the spouse may receive the prescription benefit under s. DHS 109.13 (2) (b).

DHS 109.15(4)(b)3.a.a. If the annual income of the fiscal test group does not exceed 160% of the poverty line for a 2-person family, the spouse may receive the prescription benefit under s. DHS 109.13 (2).

DHS 109.15(5)(5) If the income of the spouse was used to determine the SeniorCare benefit for the participant, the department shall determine the benefit as follows: