Page 329

• No person in any level of priority who lives with the incapacitated individual disagrees with the proposed admission, unless the person consenting also resides with, or is the spouse or domestic partner of, the incapacitated individual. • The incapacitated individual is not diagnosed as developmentally disabled or as having a mental illness at the time of the proposed admission. • The incapacitated individual does not verbally object to or otherwise actively protest the admission. (If the individual makes an objection or protest, they may be admitted to the facility, but the facility must notify Adult Protective Services for the appropriate county.) A patient’s representative could be, in order of priority, one of the following individuals: 1. A spouse or domestic partner 2. Adult child 3. Parent 4. Adult sibling 5. Grandparent 6. Adult grandchild 7. Adult close friend A physician and one advanced practice clinician must complete a Medical Certification of Capacity for Determining a Patient’s Representative Authority to Act (F-03435). The patient’s representative must sign a Patient’s Representative Declaration (F-03436). The incapacitated individual must be admitted to the facility directly from a hospital inpatient unit. A patient’s representative can make health care decisions to the same extent as a guardian of a person and enroll in Medicaid and authorize expenditures related to health care to the same extent as a guardian of the estate. The authority of a patient’s representative ends if any of the following occurs: • A court appoints a guardian to make decisions for the incapacitated individual • The incapacitated individual is discharged to a setting that is not a facility • A health care power of attorney that was not identified earlier is identified • The individual is determined to be no longer incapacitated See SECTION 20.3.7 POWER OF ATTORNEY, GUARDIAN, CONSERVATOR, OR PATIENT’S REPRESENTATIVE for information on verification requirements. See SECTION 2.5.1.1 SIGNATURES FROM REPRESENTATIVES for information on a valid signature by a patient’s representative. This page last updated in Release Number: 26-03 Release Date: 08/12/2026 Effective Date: 06/01/2026 22.6 Restoration of Benefits If it is determined that a member’s benefits have been incorrectly denied or terminated, their Medicaid should be restored from the date of the incorrect denial or termination through the time period that they would have remained eligible. If the member was incorrectly denied or terminated for BadgerCare Plus or MAPP with a premium obligation, the member should be allowed to pick the months in which they would like to receive benefits. All premiums owed for the months in which the member would like to receive benefits must be paid before the member is enrolled for those months.