Page 56

See SECTION 15.6.8 BACKDATED MONTHS for information on counting self-employment income for backdated months. 2.8.2.3 Medical Bills During Backdated Eligibility Period If a member has incurred a bill from a Medicaid-certified provider during a backdate period, the member should contact the provider to inform them to bill Medicaid. The member may be eligible to receive a refund, up to the amount the member already paid to the provider. Example 1 Mary who is 66 years old, applied for Medicaid on April 6, and was found eligible. At the time of application, Mary did not request a backdate. In September Mary is billed for a doctor’s appointment she had at the end of February. Mary can ask to have her eligibility backdated through February. She meets all non-financial and financial eligibility criteria in the months of February and March. She is enrolled in Medicaid for both months. This page last updated in Release Number: 26-02 Release Date: 04/15/2026 Effective Date: 04/15/2026 2.9 Denials and Terminations 2.9.1 Termination During the calendar month after a member’s enrollment has been terminated for a reason other than not completing a renewal, Medicaid can be reopened without requiring a new application or a new signature. The certification period for the health care assistance group (AG) prior to termination will be reinstated. The person may need to provide verification if required to complete the eligibility determination. If more than a calendar month has passed since a member’s enrollment ended, the person must file a new application or make a new request (if another health care AG is open on the case) to reopen their Medicaid. Example 1 Leroy is enrolled in MAPP with a renewal date of December 31. On September 3, he reports to his IM agency that he received a raise at work, which requires verification to be provided. MAPP coverage for Leroy is maintained while eligibility is pended. Leroy does not submit the required verification by the due date of September 23, so his eligibility for MAPP ends as of October 31. On November 7, Leroy contacts his IM agency to request that his health care be re-opened, and he provides the required verification of his income on November 20. Since this is within the calendar month after his MAPP ended, Leroy does not need to submit a new application or new signature. Leroy is re-enrolled in MAPP as of November 1. Example 2 Linda is enrolled in BadgerCare Plus and her husband Leo is enrolled in MAPP with a renewal date of January 31. On September 2, she reports to her IM agency that Leo received a gift from his aunt. The gift increased his assets to $16,000. Leo’s MAPP ends September 30 because his assets are over the MAPP program asset limit, and he is not eligible for any other form of Medicaid.

On December 10, Linda contacts her IM agency to request that Leo’s MAPP be reopened, as he purchased a vehicle (which is their only vehicle) and is no longer over the MAPP asset limit. It has been more than a calendar month since his MAPP ended, but because Linda is open for BadgerCare Plus, they do not need to submit a new application or new signature. Asset verification is received on December 15, and Leo’s eligibility for MAPP is reinstated starting December 1.