WISCONSIN DEPARTMENT OF HEALTH SERVICES 1 W. Wilson St.

WISCONSIN DEPARTMENT OF HEALTH SERVICES
Division of Health Care Access and Accountability
1 W. Wilson St.
Madison WI 53703
To:
Process Help Users
From:
Shawn Smith, Bureau Director
Bureau of Enrollment Policy and Systems
Re:
Release Date:
Effective Date:
Process Help Release 12-03
07/13/12
07/13/12
EFFECTIVE DATE
The following process additions, clarifications or changes are effective 07/13/12
unless otherwise noted. Yellow text denotes new text. Text with a strikethrough
it in the old process/policy section denotes deleted text.
CHANGES
Case Processing (1-15) > 4
Renewals > 4.7 BC+ Core
Plan Recertification
Process> 4.7.4 Processing
Fee Payments> 4.7.4.2 Fee
Payments by Phone
Old Text:
The member may choose to make a fee payment with the worker by phone. After
you have accessed the case, click on “Initiate New Request” on the BadgerCare
Plus Core Plan for Childless Adults page.
New Text:
Effective May 1, 2012, Core Plan applicant or members will no longer have the
option to pay the processing fee over the telephone. The applicant or member
should be encouraged to go to ACCESS to pay the processing fee. The fee can also
still be paid by sending in a check, credit card information, or a money order along
with the payment slip.
Case Processing (1-15) > 4
Renewals > 4.7 BC+ Core
Plan Recertification
Process> 4.7.5 BadgerCare
Eligibility Budget Pages
Old Text:
Caution!: Do not confirm a 638 failure when BCLA is pending for the fee. If the 638
failure is confirmed and the fee is later paid, BCLA will fail 077 and overrides will be
necessary to open BCLA. See PH Chapter 41.0 for overrides. Once the override
has been completed and BCLA is confirmed open, update AGOR to the correct
review date and re run eligibility, BCLA should pass.
New Text:
Caution!: Do not confirm a 638 failure when BCLA is pending for the fee. If the 638
failure is confirmed and the fee is later paid, BCLA will fail 077 and overrides will be
necessary to open BCLA. See PH Chapter 41.0 for the override process. After BCLA
is overridden and confirmed open, update AGOR to the correct review date and re
run eligibility, then BCLA will pass.
Case Processing (1-15) > 5
Case Closures > 5.2
FoodShare/TFS Case
Closure> 5.2.1 W-2 and TFS
New Text:
Eligibility for TFS benefits will be determined by CARES Client Assistance for
Reemployment and Economic Support at Adverse Action The last day of the month
a change can be made in CARES to affect eligibility for the following month. Adverse
Action is usually 13 days prior to the last day of the month to allow for a timely notice
to be generated. ( AA Adverse Action; The last day of the month a change can be
made in CARES to affect eligibility for the following month. Adverse Action is usually
13 days prior to the last day of the month to allow for a timely notice to be generated.
) in the month the last W-2 payment is issued, if the FS case is open in the benefit
determination month and the month the last W-2 payment is issued. If the FS benefit
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is reduced to zero for the month between the benefit determination month and the
month TFS begins, FoodShare will remain open with a zero allotment. The TFS
benefit amount will be calculated using the income, expenses and household size
from the FS budget for the month prior to the last month a W-2 cash payment is
received. The gross W-2 or TT amount in the benefit determination month will be
deducted from the budgeted income for the TFS calculation. This will often result in
the family receiving the maximum FS benefit for the reported household size.
Financial Processes (16-30)
> 17 Assets > 17.3 Asset
Assessment
Old Text:
Medicaid policy for asset assessments remains the same. An asset assessment
should follow the Medicaid Spousal Impoverishment policy, using the countable,
available assets the couple owns at the time of the first continuous (at least 30 days)
period of institutionalization or the first application for Community Waivers, whichever
is earlier. For further policy information see MEH 18.1.
New Text:
Medicaid policy for asset assessments remains the same. An asset assessment
should follow the Medicaid Spousal Impoverishment policy, using the countable,
available assets the couple owns at the time of the first continuous (at least 30 days)
period of institutionalization or the first application for Community Waivers, whichever
is earlier. For further policy information see MEH 18.4.
Tools (41-55) > Electronic
Case File (ECF) 45 > 45.8
The Centralized Document
Processing Unit (CDPU)>
45.8.2 CDPU Process
Effective 07-01-12
Old Text:
10. Local agency forms that list a mailing address for verification items should be
changed to the CDPU address. That address is:
CDPU
PO Box 7190
Madison, WI 53707-7190
New Text:
10. Local agency forms that list a mailing address for verification items should be
changed to the CDPU address. That address is:
CDPU
PO Box 5234
Janesville, WI 53547
Tools (41-55) > ACCESS 47 >
47.2 Access Accounts
Old Text:
47.2.1 End Case Access
In very rare situations, after establishing an account, some people may not want any
of their information to be available through ACCESS. In these situations, full viewing
individuals may choose to "End Case Access” through Check My Benefits. This
means that no one on the case, including that individual, can see his/her case
information through ACCESS. Only full viewing individuals can take this step.
ACCESS customers should only end case access if they have serious concerns
about someone being able to use their SSN, date of birth, and case information to
log into ACCESS without their permission. If someone changes his/her mind later,
they must follow "Restoring Case Access” instruction.
New Text:
47.2.1 End Case Access
In very rare situations, after establishing an account, some people may not want any
of their information to be available through ACCESS. In these situations, full viewing
individuals may choose to "Lock MY Access” through Check My Benefits. This
means that no one on the case, including that individual, can see his/her case
information through ACCESS. Only full viewing individuals can take this step. See
the ACCESS Handbook 4.10.2 for instructions.
ACCESS customers should only end case access if they have serious concerns
Process Help Release 12-03
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about someone being able to use their SSN, date of birth, and case information to
log into ACCESS without their permission.
Tools (41-55) > ACCESS 47 >
47.2 Access Accounts>
47.2.2 Restoring Case
Access
Old Text:
1. The customer sees an IM worker and provides proof of ID
2. Worker asks the local CARES coordinator to send an e-mail to the CARES Call
Center requesting that viewing privilege be restored
3. CARES Call center will forward the request to appropriate BEM technical support
staff to restore the viewing privilege, and
4. DHFS will send notification to the customer when access to Check My Benefits is
restored
New Text:
1. The customer contacts the agency to have their account access restored.
2. The worker verifies by the Check My Benefits Worker View through CWW
that this is a situation where the account access has to be restored.
3. If the message above displays, the customer sees an IM worker and
provides proof of ID,
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4. The worker asks the local CARES coordinator to send an e-mail to the DHS
CARES Call Center requesting that viewing privilege be restored.
5. The DHS CARES Call Center will forward the request to appropriate BEPS
technical support staff to restore the viewing privilege.
6. The DHS CARES Call Center will notify the IM Agency when access to
Check My Benefits is restored.
Note: If the message in Step 2 does not display, this may be a situation where the
customer needs to create an account or reset their password. More information can
be found in the ACCESS handbook, chapter 1. 1.4 has the steps for the Account
Recovery process.
Other (56-79) > Employer
Verification 56 > 56.2
Employer Verification of
Health Insurance
This section was completely rewritten. The changes are too numerous to list and are
effective July 12, 2012.
Systems Guides (80-82) > 81
ForwardHealth iChange > 81
ForwardHealth iChange>
81.5 Med Stat Code Chart
New Text:
CARES
Code
MED
STAT
Description and FPL limits
BCPA
7A
BCPN
7D
BCPA
8A
BCPN
8B
BCLA
8C
BCLA
8D
BCPM
8E
BCPM
8F
BCPA
8G
Parents >130 - 150% Eff.
4/1/08-6/30/12
Caretakers >130 - 150% Eff.
4/1/08-6/30/12
Parents >133 to 150% Eff.
7/1/12
Caretakers >133 to 150% Eff.
7/1/12
Childless Adults (CLA) >100 to
133% Eff. 7/1/12
Childless Adults (CLA) >133%
Eff. 7/1/12
Earnings Extension - 12 mo,
adult >133% Eff. 7/1/12
Child Support Extension - 4 mo,
adult Eff. 7/1/12
Disabled Parents Eff. 7/1/12
BCPN
8H
Disabled Caretakers Eff. 7/1/12
BCPE
8J
BCPE
8K
BCLA
8L
Disabled Adult - Earnings
Extension - 12 mo Eff. 7/1/12
Disabled Adult - Child Support
Extension - 4 mo Eff. 7/1/12
Disabled Adult - CLA Eff. 7/1/12
BCPA
BM
BCLA
CO
BCLA
CU
Childless Adults 0 - 100%
BCPE
X6
BCPE
X7
Earnings Extension to 12
months >100% to 133%
Child Support Extension - 4
months >100% to 133%
Caretakers >100 - 133% (Eff.
07/01/12)
Childless Adults >100% - 200%
Eff. 4/1/08-6/30/12
Process Help Release 12-03
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HealthCare
Subprogram/Category
BC+ Standard Plan
BC+ Standard Plan
BC+ Standard Plan
BC+ Standard Plan
T-19 Waiver
T-19 Waiver
T-19 Waiver
T-19 Waiver
T-19
T-19
T-19
T-19
T-19 Waiver
BC+ Standard Plan
CLA - Core Plan
Benefit Plan
CLA Core Benefit Plan
BC+ Standard Plan
BC+ Standard Plan