1. (1) Duration. Except as provided in subs. (3) to (5), and in s. DHS 109.15 and s. 49.688 (7) (a), Stats., the benefit period for SeniorCare eligibility shall be 12 consecutive calendar months.
2. (2) Eligibility begin date. Except as provided in sub. (3), a person’s SeniorCare eligibility begins on the first day of the month after the date the department receives a complete application and the person meets all of the eligibility requirements.
3. (3) Exception for medicaid recipients. If the department receives a complete application and determines that the person meets all other eligibility requirements prior to the date medical assistance eligibility ends, the person’s SeniorCare eligibility begins the day after the person’s medical assistance eligibility ends.

4. (4) Termination of SeniorCare benefit period.

   1. (a) Except as provided in sub. (5), the department shall terminate the SeniorCare benefit period of a SeniorCare participant who no longer meets the eligibility conditions in s. DHS 109.11, or who requests a withdrawal from the program under s. DHS 109.11 (5) (d).

   2. (b) The department shall restore the SeniorCare benefit period for a person terminated from SeniorCare without a break in coverage if, within one calendar month of the effective termination date, he or she does both of the following:

      1. 1. Meets all of the eligibility criteria under s. DHS 109.11.
      2. 2. Notifies the department of the change in circumstances.

   3. (c) The department shall reinstate the SeniorCare benefit period for a person who has requested a withdrawal from the program under s. DHS 109.11 (5) (d) if within 30 calendar days of the effective date of the withdrawal both of the following occur:

      1. 1. The department receives the person’s request to have SeniorCare benefits restored.
      2. 2. The person meets all of the eligibility criteria under s. DHS 109.11, including a new payment of the program enrollment fee specified in s. DHS 109.16 for persons who were issued a refund under s. DHS 109.11 (5) (d) 1.
5. (5) Continuation of benefit period for medical assistance recipients. The department may not terminate the benefit period of SeniorCare participants who lose eligibility solely due to receipt of medical assistance benefits. A SeniorCare participant is not eligible for any SeniorCare benefits or services under s. DHS 109.13 for any calendar months in which he or she receives medical assistance benefits.

6. (6) Request for new benefit period. A SeniorCare participant may request a new benefit period for SeniorCare at any time. Upon receipt of a new application, the department shall determine the participant’s eligibility for a new benefit period in the following manner unless the application is from the spouse of a participant and meets the conditions under s. DHS 109.15:

   1. (a) The person shall submit a new application as required under s. DHS 109.11.
   2. (b) The department shall redetermine eligibility when the request for a new benefit period is made beginning with the date a new complete application is received.
   3. (c) The department shall redetermine annual income for a 12-month period beginning with the date a new complete application is received.
   4. (d) The department shall redetermine which benefits and services under s. DHS 109.13 the applicant may receive.
   5. (e) The participant may withdraw the request for a new benefit period as allowed under s. DHS 109.11 (5).
   6. (f) Eligibility for the new benefit period shall begin on the first day of the month after the date a new complete application is received and all the eligibility requirements are met, including payment of a new enrollment fee specified in s. DHS 109.16.
   7. (g) Prescription drug costs that had been applied to a spend-down or deductible in a previous benefit period may not apply to the new benefit period.
   8. (h) Notwithstanding s. DHS 109.15, if a person eligible for SeniorCare requests a new benefit period at the same time the person’s spouse applies for SeniorCare or requests a new benefit period, eligibility shall be determined under this section.
   9. (i) The department shall terminate a participant’s current benefit period once the department determines eligibility for a request for a new benefit period.
7. (7) Annual eligibility review. Eligibility for a new benefit period determined under s. DHS 109.11 (6) (b) shall begin on the first day of the month immediately following the end of the previous benefit period when the department receives a complete application and all the eligibility requirements are met, including payment of a new enrollment fee specified in s. DHS 109.16, prior to the end of the 12th month of the previous benefit period.

History

History: CR 02-154: cr. Register April 2003 No. 568, eff. 5-1-03.