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This page last updated in Release Number: 08-01 Release Date: 02/01/2008 Effective Date: 02/01/2008 27.9 ILTC Nursing Home Refunds When an institutionalized person becomes eligible for Medicaid, he or she is certified with a begin date of the first of the month in which he or she became eligible. If he or she prepaid his or her patient liability for that month, the member may ask the nursing home to send the bill to Wisconsin Medicaid and ask that he or she be reimbursed for the month. Treat the refund as a reimbursement in the month it is received. (15.3.19 REIMBURSEMENTS) Do not count it as income in the month it is received. Beginning with the month following the month of receipt, count any amount he or she keeps as an available asset. He or she can avoid having the reimbursement counted as an available asset by doing any of the following: 1. Transfer it for fair market value for an exempt asset. 2. Transfer it to his or her spouse. 3. Refund it to the Medicaid program in an amount equal to what Medicaid has already paid for his or her care up to the date of the reimbursement.

This page last updated in Release Number: 08-01 Release Date: 02/01/2008 Effective Date: 02/01/2008 27.10 ILTC Liability Effective Dates Income changes which are reported timely and result in an increased patient liability or cost share have the following effective dates: • Eligibility redetermined before adverse action: Effective the first of the following month. • Eligibility redetermined after adverse action: Effective the first of the month after the following month. Retroactive patient liability or cost share increases cannot be made since the member must receive timely notice. This includes scenarios in which a member is switching from cost share to a patient liability. Decreases in patient liability or cost share are always effective the first of the month in which the decrease occurs or the decrease is reported, whichever is later. Liability changes must be reviewed when coverage was maintained following a reported change or a timely renewal. Once eligibility is able to be redetermined, liability amounts for months with coverage maintained may need to be reduced. See Process Help Section 12.18.10.1.2 Restoration of Benefits for Institutional Medicaid. Note If an Administrative Law Judge or court orders a decreased liability or cost share, the agency must follow the court order and apply changes retroactively as stated in the court order. This page last updated in Release Number: 26-03 Release Date: 08/12/2026 Effective Date: 08/12/2026