Section 10.32. General conditions of eligibility.

 

(1)   Conditions. To be eligible for the family care benefit, a person shall meet all of the following conditions:

(a) Age. The person is at least 18 years of age or will attain the age of 18 years on any day of the calendar month in which the person applies.

(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:

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.

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.

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

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

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

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

(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.

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

(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.

(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:

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

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

(c) Information related to the person's health and functional status, as required by the department.

(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) .

(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.

History: 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 .