Section DHS 109.12 - Calculation of eligible benefits and servicesPersons the department determines to be eligible for SeniorCare benefits and services under s. DHS 109.11 may be subject to program deductible and spend-down amounts that participants must pay before the participant may receive the full SeniorCare benefits and services for the remainder of a benefit period. Whether and to what extent the deductibles and spend-down amounts under s. DHS 109.13 apply to a given participant depends on the annual income of the participant's fiscal test group. The department shall calculate income for the participant's fiscal test group as follows:
(1) SENIORCARE FISCAL TEST GROUP. The SeniorCare fiscal test group shall consist solely of the applicant unless the applicant is residing with a spouse. If the applicant is residing with a spouse, the SeniorCare fiscal test group shall consist of the applicant and the applicant's spouse, unless the spouse is an SSI recipient or the spouses are living together in a nursing home.(2) ANNUAL INCOME. The department shall calculate annual income for SeniorCare applicants as follows: (a) Income shall be based on a prospective estimate of annual budgetable income under par. (c) for all persons in the SeniorCare fiscal test group.(b) The annual period used as the basis for the estimate shall be the 12 calendar months beginning with the month in which the SeniorCare application was filed.(c) Budgetable income shall consist of gross earned and unearned income with the following exceptions: 1. Self-employment income shall be calculated by deducting only estimated business expenses, losses, and depreciation from gross self-employment income.2. Income from sources exempted under federal law from consideration for Medicaid eligibility will also be exempt for SeniorCare.Wis. Admin. Code Department of Health Services DHS 109.12
CR 02-154: cr. Register April 2003 No. 568, eff. 5-1-03.