DHS 102.01(5)(b)2.b. b. He provides the agency with an affidavit in which he states that he is the child’s father and proves that he and the child’s mother lived together at the time of conception.

DHS 102.01(5)(b)2.c. c. He files with the department a declaration of paternal interest under s. 48.025, Stats., and proves that he and the child’s mother lived together at the time of conception.

DHS 102.01(5)(b)2.d. d. He provides the agency with a written statement in which he acknowledges his paternity and proves that he and the child’s mother lived together at the time of conception.

DHS 102.01(5)(b)2.e. e. He submits to the agency a sworn statement describing in sufficient detail the circumstances upon which he bases his claim to be the child’s father and the agency has no reason to doubt his credibility.

DHS 102.01 Note Note: The statement of paternity form (F-05024 for English; F-050245 for Spanish) can be obtained from the Division of Public Health, P.O. Box 309, Madison, WI 53701.

DHS 102.01(5)(c) (c) When a child or adult resides in a MA-certified skilled nursing facility,intermediate care facility, or inpatient psychiatric facility, or is hospitalized and is unable to live outside of the hospital, the agency may determine individually the eligibility of the child or adult.

DHS 102.01(5)(d) (d) When a foster child resides in a licensed foster home or a child resides in a group home, the agency shall consider the child as the primary person for purposes of application.

DHS 102.01(5)(e) (e) When a child is a parent or is pregnant, but not married and not under the care of a relative as specified in s. 49.19 (1) (a), Stats., the agency shall determine individually the eligibility of the child.

DHS 102.01(5)(f) (f) In cases where 3 generations reside together, the agency shall consider the first generation to be caring for both the second-generation and third-generation children.

DHS 102.01(5)(g) (g)

DHS 102.01(5)(g)1. 1. When a completed application is received before the death of an applicant who dies before eligibility is determined, the agency shall process and take action on the application in the same manner as with any other application.

DHS 102.01(5)(g)2. 2. An application on behalf of a deceased person may be made by an interested person who attests to the correctness of the eligibility information on behalf of the deceased.

DHS 102.01(6) (6) Providing correct and truthful information. The applicant, recipient, or person described in sub. (7) acting on behalf of the applicant or recipient is responsible for providing to the agency, the department or its delegated agent, full, correct and truthful information necessary for eligibility determination or redetermination and for disclosing assets which the agency determines may affect the applicant’s or recipient’s eligibility, including but not limited to health insurance policies or other health care plans and claims or courses of action against other parties on the part of the applicant or recipient. Changes in income, assets or other circumstances which may affect eligibility shall be reported to the agency within 10 days of the change.

DHS 102.01(7) (7) Signing the application.

DHS 102.01(7)(a) (a) In this subsection, “community spouse” and “institutionalized spouse” have the meanings provided in s. DHS 103.075 (3) (a) and (e).

DHS 102.01(7)(b) (b) Each application submitted online, over the telephone, by fax, or on paper shall be signed by the applicant or the applicant’s caretaker relative, legal guardian, authorized representative or, where the applicant is incompetent or incapacitated, by someone acting responsibly for the applicant.

DHS 102.01(7)(c) (c) When an institutionalized person who is applying for MA or an institutionalized recipient whose eligibility for MA is being redetermined has a community spouse, both the institutionalized spouse and his or her spouse, their authorized representatives or someone acting responsibly for the institutionalized spouse or his or her spouse shall sign the application. Failure of either spouse or that person’s authorized representative or someone acting responsibly on behalf of either spouse to sign the application shall result in ineligibility for the institutionalized spouse under s. DHS 103.075. Except as provided under s. DHS 103.075 (5) (e), the agency shall proceed to determine eligibility for the institutionalized spouse under s. DHS 103.04 (4).

DHS 102.01(7)(d) (d) The signatures of 2 witnesses are required when the application is signed with a mark.

DHS 102.01 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. (7), Register, March, 1993, No. 447, eff. 4-1-93; emerg. am. (intro.) and cr. (5) (h), eff. 7-1-99; am. (intro.) and cr. (5) (h), Register, March, 2000, No. 531, eff. 4-1-00; correction in (7) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; corrections in (7) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 23-046: am. (intro.), (1), r. and recr. (4), am. (5) (a), (b) (intro.), 1., 2. (intro.), a. to d., r. (5) (h), r. and recr. (7) Register April 2024 No. 820, eff. 5-1-24.

DHS 102.02 DHS 102.02 Refusal to provide information. If a person refuses to provide information necessary for the determination of eligibility, all persons whose eligibility depends upon the withheld information shall be denied eligibility.

DHS 102.02 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 102.03 DHS 102.03 Verification of information.

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)(a) (a) Income.

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.