Section 10.36. Eligibility and entitlement.

 

(1)   Entitlement. Except as provided in sub. (2) , a person who meets all of the conditions of eligibility under s. DHS 10.32 is entitled to enroll in a care management organization and to receive the family care benefit if any of the following apply:

(a) The person meets the conditions of functional eligibility at the comprehensive level under s. DHS 10.33 (2) (c) .

(b) The person meets the conditions of functional eligibility at the intermediate level under s. DHS 10.33 (2) (d) and at least one of the following applies:

1. The person is in need of adult protective services as substantiated by a county agency under s. 46.90 (2) , Stats., or specified in s. 55.01 (1f) , Stats.

2. The person is eligible for medical assistance.

(c) The person meets the criteria under s. DHS 10.33 (3) .

(2)   Phase-in of entitlement.

(a) Effective date . Except as provided in pars. (b) and (c) , within each county and for each CMO target population, entitlement to the family care benefit first applies on the effective date of a contract under which a CMO accepts a per person per month payment to provide services under the family care benefit to eligible persons in that target population in the county.

(b) Non-MA eligibles . A person who is not eligible for medical assistance is not entitled to the family care benefit until the date established by the department in accordance with s. 46.286 (3) (d) , Stats.

(c) Phase-in of capacity . To provide time for a newly established care management organization to develop sufficient capacity to serve all individuals who meet the conditions of entitlement, a care management organization may limit enrollment. If enrollment is limited during this phase-in period, a resource center may place persons otherwise entitled under sub. (1) on a waiting list until a CMO can accept the enrollment. Any waiting list created under this paragraph shall conform to department requirements.

(3)   Eligibility without entitlement. A person who is found eligible but who does not meet any of the conditions of sub. (1) (a) to (c) is not entitled to the family care benefit. The person may be placed on a waiting list to receive the family care benefit when funds are available. The county agency shall inform the person of his or her right to receive a new functional screening or financial eligibility and cost-sharing screening if the person's circumstances change. Waiting lists under this subsection shall conform to criteria established by the department. While waiting for enrollment, a person who has been found eligible but not entitled may purchase services from a CMO as provided under s. DHS 10.37 .

History: Cr. Register, October, 2000, No. 538 , eff. 11-1-00; CR 04-040 : am. (2) (b) and (3) Register November 2004 No. 587 , eff. 12-1-04; correction in (1) (b) 1. made under s. 13.93 (2m) (b) 7., Stats., Register November 2004 No. 587 ; correction in (1) (b) 1. made under s. 13.92 (4) (b) 7., Stats., Register November 2009 No. 647 .

Note

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