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• The member indicates they want to apply for a disability determination. • The member is enrolled in an adult long-term care program (Family Care, Family Care Partnership, PACE, or IRIS). Prior coverage is maintained while the Medicaid Disability Application Form, F-10112 (MADA), Authorization to Disclose Information to Disability Determination Bureau, F-14014 (ADDD), and any other necessary information (including an Asset Assessment, if appropriate) are requested. If the member is otherwise eligible for EBD Medicaid types after the MADA, ADDD, and all necessary information is collected, the prior coverage continues to be maintained while the Disability Determination Bureau (DDB) makes the determination of disability. Example 1 Hoai is enrolled in BadgerCare Plus and IRIS. On March 20, he reports an income increase from his part- time job that puts him over the limit for BadgerCare Plus. He does not have a disability determination and is not married. Because he is enrolled in a long-term care program, BadgerCare Plus must be maintained until it is determined if Hoai is eligible for Medicaid based on disability.

On March 21, a request for asset information and the MADA and ADDD are sent to Hoai.

Hoai provides the requested asset information and disability application forms by the due date, and he meets the eligibility criteria for the Medicaid Purchase Plan (MAPP) if determined disabled by the DDB. On April 10, Hoai’s disability application is sent to the DDB. Hoai’s BadgerCare Plus coverage (and IRIS enrollment) will be maintained until the DDB makes a decision, as long as he remains otherwise eligible for MAPP or another form of full-benefit Medicaid based on disability. A notice is sent informing Hoai that he is now subject to EBD reporting rules, and his existing coverage will be maintained while the DDB is making their decision.

On July 10, the DDB returns a decision that Hoai’s disability application is approved for Medicaid. His BadgerCare Plus ends on July 31, and he is enrolled in MAPP effective August 1. He remains enrolled in IRIS. 26.3.3 Program Changes If health care coverage was maintained during a redetermination of eligibility and the member’s enrollment changes to a new health care program or has a reduction in premium for a current health care program, their eligibility may need to be redetermined for the month(s) coverage was maintained. After redetermination, if a member’s enrollment changes from a limited-benefit to a full-benefit health care program, their eligibility in the new program may need to be redetermined for the months that coverage was maintained and in any month in which the member may be eligible for the new health care program. Example 1 Tim applied for health care and Family Planning Only Services (FPOS) on October 2. He was denied for BadgerCare Plus due to being over the income limit, and he opened for FPOS. On February 3, he reports a reduction in income. Verification is requested with a due date of February 23. His FPOS coverage is maintained for March. Verification is received on February 19. His income decrease makes him eligible for BadgerCare Plus with a new certification period starting April 1. However, because the income reduction was reported in February and verified timely, his eligibility for BadgerCare Plus must also be determined retroactively for February and March. Eligibility must be retroactively determined in situations where health care coverage was maintained for one household member, and after the redetermination of eligibility, another household member that was previously not eligible for health care is newly eligible. Eligibility is determined back to the date the change was reported.