DHS 103.05(1)(a)(a) A family has been determined financially ineligible for BadgerCare Plus-related MA only and there is a child in the family who is SSI-related but not receiving SSI payments.

DHS 103.05(2)(2) Establishing child-only MA groups. In child-only cases, the child or children of each legal parent shall form their own MA group and shall be tested for financial eligibility with the children’s own income and assets, if any, plus the income and assets deemed to the children of this group according to subs. (3) and (4).

DHS 103.05(3)(b)(b) In cases of an SSI-related child where 2 parents are in the home, parental assets in excess of the SSI asset limit for 2 persons shall be deemed to the blind or disabled child. Where there is one parent, parental assets in excess of the SSI asset limit for one person shall be deemed to the blind or disabled child in accordance with 42 CFR 435.845.

DHS 103.05(4)(a)(a) To the third-generation child. All of the net income of the second-generation minor parent shall be deemed to the third-generation child.

DHS 103.05(4)(b)(b) To the stepchild. The income deemed to the stepchild shall be the remainder of the total of the net income of the legal parent minus the categorically needy income standard based on the number of ineligible family members.

DHS 103.05(4)(c)(c) To the SSI-related child. The amount of parental monthly income deemed to the SSI-related child shall be determined according to the procedure set out in this paragraph. The department shall adjust the monthly amounts in accordance with changes in the SSI program. Beginning with unearned income, parental monthly gross income shall be deemed to each ineligible child to bring the child’s income up to an amount equal to one-half the maximum federal share of the SSI benefit paid to a single individual living in his or her own household. The remaining parental income shall be deemed to the SSI-related child as follows:

DHS 103.05(4)(c)1.1. When the only type of parental income remaining is unearned, $20 shall be subtracted. Then, where there are 2 parents, an amount equal to the maximum federal share of the SSI benefit paid to a couple living in their own household shall be subtracted, and where there is one parent, an amount equal to the maximum federal share of the SSI benefit paid to an individual living in his or her own household shall be subtracted. The remaining income shall be considered available to the SSI-related child as unearned income.

DHS 103.05(4)(c)2.2. When the only type of parental income remaining is earned, $85 shall be subtracted. Then, where there are 2 parents, an amount equal to 3 times the maximum federal share of the SSI benefit paid to an individual living in his or her own household shall be subtracted, and where there is one parent, an amount equal to 2 times the maximum federal share of the SSI benefit paid to an individual living in his or her own household shall be subtracted. The remaining income shall be considered available to the SSI-related child as unearned income.

DHS 103.05(4)(c)3.3. When parental income remaining is a mix of unearned and earned, $20 shall be subtracted using unearned income first. From any remaining earned income, $65 shall be subtracted and then one-half of the remainder. When there are 2 parents, an additional amount equal to the maximum federal share of the SSI benefit paid to a couple living in their own household shall be subtracted, and when there is one parent, an additional amount equal to the maximum federal share of the SSI benefit paid to an individual living in his or her own household shall be subtracted. The remaining income shall be considered available to the SSI-related child as unearned income.

DHS 103.05(5)(5) Income limits for child-only MA groups. The eligibility of an SSI-related child shall be determined by testing against the SSI-related income standard for one person.

DHS 103.05 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; CR 23-046: am. (1) (intro.), (a), r. and recr. (1) (b), r. (1) (c) to (e), r. (5) (a), renum. (5) (b) to (5) Register April 2024 No. 820, eff. 5-1-24.

DHS 103.06(1)(a)(a) In determining the eligibility of an institutionalized person, only the assets actually available to that person shall be considered.

DHS 103.06(1)(b)1.1. The institutionalized person’s home is currently occupied by the institutionalized person’s spouse or a dependent relative. In this subdivision,“dependent relative” means a son, daughter, grandson, granddaughter, stepson, stepdaughter, in-law, mother, father, stepmother, stepfather, grandmother, grandfather, aunt, uncle, sister, brother, stepbrother, stepsister, halfsister, halfbrother, niece, nephew or cousin who is financially, medically or otherwise dependent on the institutionalized person;

DHS 103.06(1)(b)2.2. The institutionalized person intends to return to the home and the anticipated absence from the home, as verified by a physician, is less than 12 months; or

DHS 103.06(1)(b)3.3. The anticipated absence of the institutionalized person from the home is for more than 12 months but there is a realistic expectation, as verified by a physician, that the person will return to the home. That expectation shall include a determination of the availability of home health care services which would enable the recipient to live at home.

DHS 103.06(1)(c)(c) If none of the conditions under par. (b) is met, the property is no longer the principal residence and becomes non-homestead property.

DHS 103.06(1)(d)(d) When income that has been protected for institutionalized recipients accumulates to the point that the asset limit is exceeded, MA eligibility shall terminate. Eligibility may not be reinstated until the assets are below the limit at which time a new application shall be required.

DHS 103.06(1)(e)(e) To maintain continuous MA eligibility the recipient may apply assets as a refund of MA benefits to the department. In no instance may refunds exceed benefits received.