BCS 211404 (02/08/2024)
Declined long-term disability payments still counted as BCP income

Preliminary Recitals

Pursuant to a petition filed on December 13, 2023, under Wis. Stat. § 49.45(5)(a), to review a decision by the Washington County Department of Social Services regarding Medical Assistance (MA), a hearing was held on January 17, 2024, by telephone.

The issue for determination is whether the agency correctly terminated Petitioner’s BadgerCare Plus (BCP) enrollment, effective November 1, 2023.

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: Ken Benedum
Washington County Department of Social Services
333 E. Washington Street
Suite 3100
West Bend, WI 53095

ADMINISTRATIVE LAW JUDGE:
Nicole Bjork
Division of Hearings and Appeals

Findings of Fact

1. Petitioner (CARES # —) is a resident of Washington County and received BCP benefits.
2. On October 10, 2023, Petitioner informed the agency that her income included a total of $185.84 per month from —, and a $1,993.47 per month in long-term disability payment while Petitioner’s long-term disability claim was processed. Petitioner’s gross monthly income was $2,179.31 per month and her annual income for 2023 was calculated to be $14,850.08.
3. On October 16, 2023, the agency sent a notice to Petitioner informing her that her enrollment in BCP would be terminated, effective November 1, 2023. The termination was due to an increase in her unearned income from the long-term disability payments, which put her over the income limit to receive benefits.
4. On October 19, 2023, Petitioner contacted — to withdraw her claim for long-term disability. Petitioner stated that the long-term disability payments would put her over the monthly income limit to receive BCP Plus and also reduced her monthly FS allotment. Therefore, she no longer wanted to pursue long-term disability payments.
5. On December 13, 2023, Petitioner filed an appeal of the October 16, 2023, notice informing her that her BCP enrollment would be terminated. At hearing, Petitioner noted that she was not receiving the long-term care disability and therefore that amount should not be counted as part of her income.
6. The agency representative testified at hearing that even if Petitioner was not receiving the long-term disability, that money was available to her but she was choosing not to pursue those payments specifically so that she was eligible for BCP Plus and additional FS benefits. Since the payments were available to her, that income was required to be included in calculating her benefits.

Discussion

BadgerCare+ (BCP) is a state and federal program that provides health coverage for low-income Wisconsin residents. To be eligible for BCP, a person must meet certain non-financial and financial requirements. The income limit for childless adults is 100% of the federal poverty level (FPL). BCP Eligibility Handbook, § 16.1. All taxable gross income is counted. Id. If a household’s annual income is below 100% of the annual FPL, the household may be eligible for coverage.

BadgerCare+ policy requires that “other income”, which includes disability payments, is any payment that a member receives from sources other than employment that are counted as taxable income. BCP Eligibility Handbook § 16.5.11. Policy further requires that the agency count the gross payment in the person’s income total. Id.

Petitioner does not dispute that with the long-term disability payment included, she is over the income limit. However, Petitioner does not believe that the long-term disability payments should be included in her gross monthly income because she asked to stop receiving long-term disability payments while pursing her claim because receiving that money put her over the income limit for BPC.

Petitioner believes that since she has declined to pursue long-term disability and asked to cease receiving payments, that she should now be eligible for BCP. However, the BCP Eligibility Handbook is clear that if the payments are available, the agency must include that as income even if the participant chooses not to utilize those payments.

When it is known that a member of the group is eligible for income or an increased amount of income:

1. If the amount is known, count the income as if the person is receiving it.
2. If the amount is unknown, ignore the income.

Example

Marianne is entitled to unemployment compensation benefits of $430. However, she declined a $100 increase offered by unemployment compensation, and the amount of her check remains at $430. Since the full entitlement amount is known, the available income is $530.

BCP Eligibility Handbook § 16.1.2.

In this case, Petitioner was receiving $1,993.47 per month while her long-term disability claim was processed. Therefore, the agency knows the amount that Petitioner was receiving. When Petitioner discovered that this amount would put her over the income limit to receive BCP, she contacted Unum and declined to receive the long-term disability or pursue the claim. Even though Petitioner declined the amount, it still must be counted per the regulations noted above.

I do not have the authority to bypass the law that has set forth the income limit or methods of determining gross income. Even if it seems unfair to Petitioner, I cannot deviate from the income requirements established under the law. See, Wisconsin Socialist Workers 1976 Campaign Committee v. McCann, 433 F. Supp. 540, 545 (E.D. Wis. 1977).

Conclusions of Law

The agency correctly terminated Petitioner’s BCP effective November 1, 2023 because she was over the income imit.

THEREFORE, it is

Ordered

That this appeal is dismissed.

[Request for a rehearing and appeal to court instructions omitted.]