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5.9.5 Eligibility Medicaid coverage based on a presumptive disability determination begins on the date the person is found presumptively disabled by DDB or the IM worker. If the presumptive disability determination is made by the IM worker, Medicaid coverage should begin the date the complete Medicaid Presumptive Disability (F-10130) form is received by the IM agency, if all other eligibility requirements are met. The effective date should not be delayed based on the date the IM worker takes action to confirm the case. Example 1 Jane contacted her IM agency and applied for Medicaid on July 3. She reported being in urgent need of medical services due to muscular dystrophy. The IM worker determines that Jane would be eligible based on presumptive disability and requests that a medical professional complete and sign the Medicaid Presumptive Disability (F-10130) form to attest to the urgent need and impairment. Jane’s physician completes and returns the form to the IM agency on July 12. The IM worker processes the verification on July 14. Jane is found presumptively disabled and eligible for Medicaid effective July 12.

Example 2 Bob is Jack’s son and authorized representative. Bob applied for Medicaid on behalf of his father by telephone on June 20. He reported to the IM worker that Jack had a stroke six weeks ago and is in urgent need of medical services. The IM worker determines that Jack may be eligible based on presumptive disability but requests that a medical professional complete and sign the Medicaid Presumptive Disability (F-10130) form to attest to the urgent need and impairment. Bob also needs to verify Jack’s assets. The completed Medicaid Presumptive Disability form, attesting to the impairment and urgent need, is received by the IM agency on July 2, and verification of Jack’s checking account is received July 12. The IM worker processes the verification on July 15. The worker determines that Jack is presumptively disabled and eligible for Medicaid effective July 2. Because CARES usually certifies Medicaid from the beginning of the month, the IM worker must manually complete a Medicaid/BadgerCare Plus Eligibility Certification form (F-10110) to apply the correct begin date. The form can be returned by fax to 608-221-8815 or by mail to the following address: ForwardHealth Eligibility Unit P.O. Box 7636 Madison, WI 53707 Eligibility cannot be granted prior to the date the presumptive disability was determined until DDB makes a formal disability determination (when the case folder is returned to the IM agency). Once DDB does the final determination, eligibility may be backdated up to three months prior to the month of application but no earlier than the date of disability onset, provided all other eligibility requirements are met. The applicant does not need to submit a new application or signature. When backdating eligibility after DDB has made a formal disability determination, the member could qualify for Medicaid by meeting a three-month deductible even if they had excess income in the three- month backdate period. This is an exception to the normal six-month Medicaid deductible requirements. The deductible amount for this three-month deductible period will be the total excess income for those same three months. All other deductible rules apply. The member can be certified for Medicaid for that period on the first day they meet the deductible during that three-month period.