To be eligible for Medicaid, an applicant must verify his or her income. In this case, the petitioner tried to fax the verification from a public library to two different fax numbers, but the agency never received it. Although ALJ Beth Whitaker was sympathetic and found the petitioner made a good faith effort, she concluded the agency was correct to deny the application for failure to provide verification.
This decision was published with support from the Elder Law & Special Needs Section of the State Bar of Wisconsin and the Wisconsin chapter of the National Academy of Elder Law Attorneys.
Preliminary Recitals
Pursuant to a petition filed on December 11, 2023, under Wis. Stat. § 49.45(5)(a), to review a decision by the Dane Cty. Dept. of Human Services regarding Medical Assistance (MA), a hearing was held on January 17, 2024, by telephone.
The issue for determination is whether
There appeared at that time the following persons:
PARTIES IN INTEREST:
Petitioner:
—
Respondent:
Department of Health Services
1 West Wilson Street, Room 651
Madison, WI 53703
By: Kelli Robl
Dane Cty. Dept. of Human Services
1819 Aberg Avenue
Suite D
Madison, WI 53704-6343
ADMINISTRATIVE LAW JUDGE:
Beth Whitaker
Division of Hearings and Appeals
Findings of Fact
- Petitioner (CARES # —) is a resident of Dane County.
- On October 30, 2023, petitioner applied for BadgerCare Plus (BCP) Medical Assistance benefits.
- On October 30, 2023, the agency issued to petitioner a summary of information she provided in her application.
- On October 31, 2023, the agency issued to petitioner a notice instructing her to provide proof of employment and earned income for —, a member of her household, from — by November 29, 2023.
- On November 27, 2023, petitioner unsuccessfully attempted to fax proof of income to the agency.
- The agency did not receive the required verification by November 29, 2023 nor did it receive from petitioner a request to extend the deadline or any other communication.
- On November 30, 2023, the agency issued to petitioner an About Your Benefits notice informing her that her application for Medical Assistance was denied because she failed to provided required verification.
Discussion
BadgerCare Plus is Wisconsin’s medical assistance program for those who are not elderly or disabled. Adults are ineligible if their household income exceeds the federal poverty level. Wis. Stat. § 49.471(4)(a); Medicaid Eligibility Handbook § 39.5; BadgerCare Plus (BCP) Handbook, § 50.1.To be eligible for BadgerCare Plus, a person must meet certain non-financial and financial requirements. BCP Handbook 1.1.1.
Proof of certain information is required to determine eligibility for BadgerCare Plus. Mandatory and questionable items must be verified at application, renewal, person addition or deletion, or when there is a change in circumstance that affects eligibility or benefit level. One time only verification items do not need to be re-verified. BCP Handbook 9.1. Income is a mandatory verification item. BCP Handbook 9.9.6. Verification means to establish the accuracy of verbal or written statements made by, or about a group’s circumstances. Case files or case comments must include documentation for any information required to be verified to determine eligibility or benefit levels.
In this case, the agency issued a request for verification of the Petitioner’s household income on October 31, 2023. Petitioner received the notice. She and — testified that they made a good faith effort to provided the requested income verification information by going to a public library location to fax the information to two different fax numbers. Petitioner provided documentation of two faxes transmitted on the afternoon of November 27, 2023, one of which was documented to have been received. Petitioner was unable to say what numbers the documents were faxed to. She did not have evidence that the agency received the information. The agency representative testified that she thoroughly investigated the matter and found no evidence that the November 27, 2023 fax was received. (She also noted that after petitioner’s application was denied, the agency obtained income information for — for November and December 2023 through employer-reported information to SWICA (State Wage Information Collection Agency) but still does not have information to verify October 2023 wages.)
Based on this hearing record, the agency did not receive the required verification. It was therefore unable to establish that petitioner was eligible for Medical Assistance. I am sympathetic to petitioner because it appears that she made significant effort to provide the required information and either due to her inadvertent error or for reasons beyond her control, she was unsuccessful. I am not able to take her intentions and good faith efforts into account in the interests of fairness. It is the long-standing policy of the Division of Hearings & Appeals that its assigned administrative law judges do not possess equitable powers, and cannot base a ruling upon an idea of what is deemed fair. See, Wisconsin Socialist Workers 1976 Campaign Committee v. McCann, 433 F. Supp. 540, 545 (E.D. Wis. 1977). This office must limit its review to the law as set forth in statutes, federal regulations, and administrative code provisions. Under law, petitioner was required to provide proof by the agency’s deadline and failed to do so. I must find that the agency correctly denied petitioner’s October 30, 2023 application for BadgerCare Plus effective October 1, 2023.
However, as the agency representative stated at hearing, medical assistance eligibility can be made retroactive to ”the first day of the month 3 months prior to the month of application.” Wis. Admin. Code, § DHS 103.08(1). The Medicaid Eligibility Handbook states the following in regard to retroactive eligibility:
… If certifying for retroactive BadgerCare Plus, do not go back further than the first of the month, three months prior to the application month. Certify the person for any backdate month in which he or she would have been eligible had he or she applied in that month. In the case of children, certify the person for any backdate month in which he or she would have been eligible had he or she applied in that month and in which their assistance group income was at or below the appropriate FPL level for their age group. …
Medicaid Eligibility Handbook, § 25.8.1
If she has not already done so at the time of receipt of this decision, petitioner is advised to file a new application for BCP benefits and request backdating to October 1, 2023.
Conclusions of Law
The agency correctly found petitioner ineligible for Medical Assistance effective October 1, 2023 based on her October 30, 2023 application because she failed to provided information required for verification of income.
THEREFORE, it is
Ordered
That the petition for review is dismissed.
[Request for a rehearing and appeal to court instructions omitted.]