49.465 Presumptive medical assistance eligibility.
(1) In this section, “qualified provider" means a provider which satisfies the requirements under 42 USC 1396r-1 (b) (2), as determined by the department.
(2) A pregnant woman is eligible for medical assistance benefits, as provided under sub. (3), during the period beginning on the day on which a qualified provider determines, on the basis of preliminary information, that the woman's family income does not exceed the highest level for eligibility for benefits under s. 49.46 (1) or 49.47 (4) (am) or (c) 1. and ending as follows:
(a) If the woman applies for benefits under s. 49.46 or 49.47 within the time required under sub. (4), the day on which the department or the county department under s. 46.215, 46.22 or 46.23 determines whether the woman is eligible for benefits under s. 49.46 or 49.47.
(c) If the woman does not apply for benefits under s. 49.46 or 49.47 within the time required under sub. (4), the last day of the month following the month in which the provider makes the determination under this subsection.
(3) The department shall audit and pay allowable charges to a provider certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a recipient under this section only for ambulatory prenatal care covered under s. 49.46 (2).
(4) A woman who is determined to be eligible under this section shall apply for benefits under s. 49.46 or 49.47 on or before the last day of the month following the month in which the qualified provider makes that determination.
(5) A qualified provider which determines that a woman is eligible under this section shall do all of the following:
(a) Notify the department of that determination within 5 working days after the day the determination is made.
(b) Notify the woman of the requirement under sub. (4).
(6) The department shall provide qualified providers with application forms for medical assistance under ss. 49.46 and 49.47 and information on how to assist women in completing the forms.
History: 1987 a. 27, 307, 413; 1989 a. 9; 1989 a. 31 ss. 1460p, 2909g, 2909i; 1991 a. 269; 1995 a. 289; 1997 a. 27; 2011 a. 10, 32.
Structure Wisconsin Statutes & Annotations
Wisconsin Statutes & Annotations
Chapter 49 - Public assistance and children and family services.
49.02 - Relief block grant administration.
49.029 - Block grants to tribal governing bodies; medical relief.
49.08 - Recovery of relief and other assistance.
49.114 - Contract powers of the department.
49.131 - Electronic transfer of benefits.
49.134 - Child care resource and referral service grants.
49.136 - Child care start-up and expansion.
49.137 - Child care quality improvement.
49.1375 - Early childhood excellence initiative.
49.138 - Emergency assistance for families with needy children.
49.1385 - Grants for services for homeless and runaway youth.
49.139 - Emergency shelter funding.
49.141 - Wisconsin works; general provisions.
49.143 - Wisconsin works; agency contracts.
49.145 - Wisconsin works; eligibility for employment positions.
49.1452 - Payment of support arrears.
49.1455 - Child support demonstration project.
49.147 - Wisconsin works; work programs and job access loans.
49.1473 - Wisconsin works; domestic abuse screening and training.
49.148 - Wisconsin works; wages and benefits.
49.149 - Wisconsin works; education and training.
49.15 - Wisconsin works; 2-parent families.
49.151 - Wisconsin works; sanctions.
49.1515 - Determining nonparticipation.
49.152 - Review of agency decisions.
49.153 - Notice before taking certain actions.
49.155 - Wisconsin Shares; child care subsidy.
49.157 - Wisconsin works; transportation assistance.
49.159 - Wisconsin works; noncustodial and minor and other custodial parents.
49.161 - Wisconsin works; overpayments.
49.162 - Substance abuse screening and testing for certain work experience programs.
49.163 - Transform Milwaukee Jobs program and Transitional Jobs program.
49.1635 - Wisconsin Trust Account Foundation.
49.165 - Domestic abuse grants.
49.167 - Alcohol and other drug abuse treatment grant program.
49.175 - Public assistance and local assistance allocations.
49.19 - Aid to families with dependent children.
49.197 - Fraud investigation and reduction and error reduction.
49.22 - Child and spousal support; establishment of paternity; medical liability.
49.225 - Ordering genetic tests.
49.227 - Program for publication of delinquent child support obligors.
49.24 - Child support incentive payments.
49.25 - Incentive payments for identifying children with health insurance.
49.255 - Case management incentive payments.
49.257 - Milwaukee child care grant program.
49.265 - Community action agencies.
49.273 - Research, investigations.
49.275 - Cooperation with federal government.
49.32 - Department; powers and duties.
49.325 - County department budgets and contracts.
49.34 - Purchase of care and services.
49.343 - Rates for residential care centers, group homes, and child welfare agencies.
49.348 - Recidivism reduction program.
49.35 - Public assistance; supervisory functions of department.
49.36 - Work experience program for noncustodial parents.
49.37 - Offender reentry demonstration project.
49.38 - Menominee Enterprises, Inc., bonds, acquisition.
49.385 - No action against members of the Menominee Indian tribe in certain cases.
49.45 - Medical assistance; administration.
49.452 - Counting promissory notes as assets for certain Medical Assistance programs.
49.453 - Divestment of assets.
49.454 - Treatment of trust amounts.
49.455 - Protection of income and resources of couple for maintenance of community spouse.
49.46 - Medical assistance; recipients of social security aids.
49.463 - Ineligibility for noncompliance with child support determinations and obligations.
49.465 - Presumptive medical assistance eligibility.
49.468 - Expanded medicare buy-in.
49.47 - Medical assistance; medically indigent.
49.472 - Medical assistance purchase plan.
49.475 - Information about assistance program beneficiaries; electronic submission of claims.
49.49 - Medical assistance offenses.
49.493 - Benefits under uninsured health plans.
49.496 - Recovery of correct medical assistance payments.
49.498 - Requirements for skilled nursing facilities.
49.499 - Nursing facility resident protection.
49.68 - Aid for treatment of kidney disease.
49.682 - Recovery from estates; disease aids and funeral expenses.
49.683 - Cystic fibrosis aids.
49.685 - Hemophilia treatment services.
49.686 - AZT and pentamidine reimbursement program.
49.687 - Disease aids; patient requirements; rebate agreements; cost containment.
49.688 - Prescription drug assistance for elderly persons.
49.70 - County home; establishment.
49.703 - County homes; commitments; admissions.
49.71 - County hospitals; establishment.
49.713 - County hospitals; admissions.
49.72 - County infirmaries; establishment.
49.723 - County infirmaries, admissions; standards.
49.726 - County infirmaries; cost of treatment, care and maintenance of patients.
49.729 - County infirmaries; fees and expenses of proceedings.
49.73 - Residential care institutions; establishment.
49.74 - Institutions subject to chapter 150.
49.76 - Department duties relating to hunger prevention.
49.77 - State supplemental payments.
49.775 - Payments for the support of children of supplemental security income recipients.
49.776 - Payment of support arrears.
49.78 - Income maintenance administration.
49.79 - Food stamp administration.
49.791 - Substance abuse screening, testing, and treatment for employment and training programs.
49.793 - Recovery of food stamps.
49.796 - Food stamp reinstatement.
49.797 - Electronic benefit transfer.
49.81 - Public assistance recipients' bill of rights.
49.82 - Administration of public assistance programs.
49.823 - Public benefit database review.
49.825 - Department administration in Milwaukee County.
49.826 - Administration of child care provider services in certain counties.
49.83 - Limitation on giving information.
49.835 - Statements in applications.
49.84 - Verification of public assistance applications.
49.845 - Fraud investigation and error reduction.
49.846 - Jurisdiction of the department of justice.
49.847 - Recovery of incorrect payments under certain public assistance programs.
49.849 - Recovery of correct payments under certain public assistance programs.
49.852 - Delinquent support payments; pension plans.
49.853 - Financial record matching program.
49.854 - Liens against property for delinquent support payments.
49.855 - Certification of delinquent payments.
49.856 - Notification of delinquent payments.
49.858 - General provisions related to administrative support enforcement.
49.86 - Disbursement of funds and facsimile signatures.
49.89 - Third party liability.