WFC 213597 (06/25/2024)
Funeral aids program required posthumous MA application

Preliminary Recitals

Pursuant to a petition filed on May 29, 2024, under Wis. Admin. Code §HA 3.03 (1);, to review a decision by the Division of Medicaid Services regarding Medical Assistance (MA), a hearing was held on June 19, 2024, by telephone.

The issue for determination is whether the respondent correctly determined that the petitioner was ineligible for funeral and cemetery aid because he was not in a qualifying category.

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: Sara Warwick
Division of Medicaid Services
PO Box 309
Madison, WI 53701-0309

ADMINISTRATIVE LAW JUDGE:
Jason M. Grace
Division of Hearings and Appeals

Findings of Fact

1. Petitioner (CARES # —) was a resident of Brown County. He died on February — 2024.
2. On April 3, 2024, the respondent received a Wisconsin Funeral and Cemetery Aid Program (WFCAP) application from — for services rendered to the petitioner.
3. By decision dated April 29, 2024, the respondent denied the WFCAP application on grounds that the petitioner was not receiving any benefits to qualify for WFCAP on the date of his death.
4. On May 29, 2024, — filed an appeal.

Discussion

Wisconsin law requires the department to pay a portion of the cemetery expenses and funeral and burial expenses of indigent recipients of AFDC, W-2 benefits, Supplemental Security Income (SSI), or medical assistance under certain circumstances. Wis. Stat., §49.785(1).

The program policy is found in the WFCAP Manual, available over the internet at http://www.emhandbooks.wi.gov/wfcap/fcap.htm. The WFCAP Manual, at §1.1 and 1.3, makes clear that the decedent must have been in a qualifying category on the date of his death. Petitioner’s representatives have not established eligibility for WFCAP benefits.

1.3 Potentially Eligible Decedents

DHS may issue WFCAP payments for the unmet funeral, cemetery, and crematory expenses of a person who on the confirmed date of death, met at least one of the following criteria:

1. The decedent was a Wisconsin Works (W-2 ) participant (paid placement only).
2. The decedent was a child for whom a Caretaker Supplement (CTS) or Kinship Care benefit was being made on their behalf.
3. The decedent was an Elderly Blind Disabled categorically needy EBD-related Medicaid individuals, except for Medicaid Purchase Plan (MAPP).
4. The decedent was a parent or caretaker relative receiving BadgerCare Plus with family income that does not exceed 50% of the federal poverty level.
5. The decedent was a child receiving foster care or adoption assistance.
6. The decedent was a child under age six or was a pregnant woman receiving BadgerCare Plus with family income that did not exceed 185% of the federal poverty level.
7. The decedent was a child at least age six, but not yet 19, receiving BadgerCare Plus with family income that did not exceed 100% of the federal poverty level.
8. The decedent was a person eligible for categorically or medically needy institutional Medicaid at the time of death.
9. The decedent participated in one of Wisconsin’s Home and Community-Based Waiver Programs, including IRIS (Include, Respect, I Self-Direct), or community waiver Medicaid Purchase Plan (MAPW).
10. The decedent was a member of Family Care.
11. The decedent was a Tuberculosis-Related (TB-Related) Only Medicaid recipient.
12. The decedent was the fetus of a woman in a WFCAP-qualifying Medicaid or BadgerCare Plus category as identified in Section 1.3 Potentially Eligible Decedents.
13. The decedent was a participant in the Katie Beckett Program.
14. The decedent was a Supplemental Security Income (SSI), SSI State Supplement (SSI-SSP), or SSI Medicaid recipient who was a Wisconsin resident.
15. The decedent was an individual who met a Medicaid deductible and also qualified for a home-based program.

Note: There may be additional conditions that the decedent must have met on the confirmed date of death winthin [sic] the above programs in order to be considered potentially eligible.

Funeral, cemetery, and crematory expenses will not be paid for any individual who did not meet at least one of the above criteria on the confirmed date of death.

Note: When requesting payment for a stillborn of a Medicaid member, or live birth of a Medicaid member, service providers must provide all required demographic information for the Medicaid member on the application. In addition, the mother’s name, Social Security number, and date of birth are required.

WFCAP Manual, § 1.3; see also Wis. Stats. § 49.785(1c).

Wis. Stat. §49.785 provides for WFCAP eligibility only if the decedent was a recipient of certain benefits. The respondent’s representative testified at hearing that petitioner was not receiving any of the benefits listed above to qualify for WFCAP at the time of his death. This was not rebutted. The respondent’s representative further indicated that petitioner last received benefits in FowardHealth on September 30, 2023. As petitioner was not a qualifying recipient, under state law he was not eligible for WFCAP. I must, therefore, conclude that he was ineligible for the WFCAP benefit.

It was indicated by — that the petitioner was in the process of applying for a qualifying health care benefits but eligibility was not able to be determined prior to his death. The WFCAP policy provides the following under such circumstances:

1.6 Posthumous Health Care Application

If a decedent was not enrolled in one of the programs identified in Section 1.3 Potentially Eligible Decedents at the time of death, the service provider may still qualify for a WFCAP payment for the decedent’s expenses if at the time of death or due to the cause of death, the decedent was eligible for Medicaid. Prior to the service provider submitting a WFCAP application, the decedent’s representative or family must contact the decedent’s income maintenance agency for a posthumous application to determine if the decedent was eligible for Medicaid. WFCAP does not determine income maintenance eligibility. Therefore, WFCAP cannot answer any questions regarding eligibility for decedents beyond stating ‘potentially eligible’ or ‘not eligible.’

WFCAP Manual, § 1.3.

As of the hearing, a posthumous health care application had not been granted that placed the petitioner in a qualifying category at the time of his death. Thus, the WFCAP application was correctly denied. If the petitioner’s family or representative believes that the posthumous health care application was incorrectly denied or processed, it can file an appeal with the DHA. If the health care application is later approved and it places the petitioner in a WFCAP qualifying category, then — may seek to file a new application for WFCAP benefits. Of note, a WFCAP application “ must be received no later than the end of the 12th calendar month following the month of the decedent’s date of death. An application received after that time period will be denied.” WFCAP Manual, § 2.11.

Conclusions of Law

The respondent correctly denied the petitioner’s April 3, 2024 application for the Wisconsin Funeral and Cemetery Aids Program as petitioner was not in a qualifying category at time of his death.

THEREFORE, it is

Ordered

That the appeal is dismissed.

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