When verifying income with BadgerCare Plus, the agency must “advise the applicant of the specific verification required.” If the applicant “is able to produce required verifications but refuses or fails to do so,” the benefits will be denied or ended after adequate notice. In this case, the petitioner did a little contract work on an as-needed basis. To verify this, he sent in what he had: a couple of invoices showing the total amounts he had been paid and an email from the employer explaining the work arrangement. But because he did not fill out a self-employment income report, the agency ended his benefits. ALJ Teresa Perez concluded the agency had not given adequate notice that the report was required, explaining:
The agency’s written verification requests did not, however, say that he must submit a SEIRF; one of those requests indicated that SEIRFs were an example of what could be used to comply with the agency’s request.
… [T]he agency should have reached out to Petitioner to clarify that they were seeking information regarding his expenses and/or to know whether his income would be ongoing.
This decision was published with support from the Wisconsin chapter of the National Academy of Elder Law Attorneys.
Preliminary Recitals
Pursuant to a petition filed on November 26, 2024, under Wis. Stat. § 49.45(5)(a), to review a decision by the Milwaukee Enrollment Services regarding Medical Assistance (MA), a hearing was held on January 9, 2025, by telephone.
The issue for determination is whether the agency properly terminated Petitioner’s BadgerCare Plus as of November 1, 2024.
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: Michelle Olusegan
Milwaukee Enrollment Services
1220 W Vliet St
Milwaukee, WI 53205
ADMINISTRATIVE LAW JUDGE:
Teresa A. Perez
Division of Hearings and Appeals
Findings of Fact
- Petitioner (CARES # —) is a 21-year old resident of Milwaukee County who previously received BadgerCare Plus as a single person assistance group from August 1, 2023 through October 31, 2024.
- On September 20, 2024, Petitioner notified the agency that he is enrolled in college full time, that he had stopped working at —, and that he had started working for —.
- Petitioner works for — on an as needed basis. As of the date of the hearing in this matter, he had worked for them on two occasions, once on August 20, 2024 and once on September 28, 2024 and was not scheduled to do any further work for that entity.
- On September 23, 2024, the agency mailed Respondent a request to verify his earned income by October 14, 2024.
- On October 14, 2024, Petitioner provided to the agency an e-mail from — which stated Petitioner is an independent contractor rather than an employee, that he had begun “contract work” on September 28, 2024 and that he worked “as needed.” In addition, Petitioner provided an Invoice dated August 20, 2024 that indicated that “—” (i.e., —) paid him $137.50 for production assistance work performed from 12:00 – 5:30 on that date.
- On October 18, 2024, the agency mailed a request to Petitioner to provide proof of monthly income and expenses for — by November 6, 2024 and included the following notation: “Examples: Enclosed Self-Employment Income Report form or bookkeeping records.”
- By notice dated October 16, 2024, the agency informed Petitioner that his BadgerCare Plus would end on November 1, 2024 because he did not provide required proof of his “employment at — including: Expected monthly income before taxes or deductions and number of hours worked per pay period.”
- In or around the second week of November 2024, Petitioner began working three hours per week in a work study job at — where he is enrolled in school. He earns $12 per hour and is paid every other week. He received gross pay of $36 on November 22, 2024, $72 on December 6, 2024, and $78 on December 20, 2024.
- On November 26, 2024, Petitioner filed a request for fair hearing regarding the agency’s decision to terminate his BCP coverage.
Discussion
To be eligible for BCP, individuals must have income that is less than the applicable program income limit. Parents and caretakers of minor children as well as childless adults are subject to an income limit of 100% of the federal poverty level (FPL). BadgerCare Plus Eligibility Handbook (BCPH) §16.1.1. Generally, the test group size of a tax filer who is not being claimed as a tax dependent by another individual includes himself, his spouse (if any), and all of his tax dependents. BCPH §2.3 and 42 C.F.R. §435.603(f)(1). As of February 2024, the income limit for a one-person test group was $1,255 per month (i.e., $15,060 per year). Wis. Stat. § 49.45(23)(a); BCPH § 50.1. That amount increased to $1,304.17 as of February 1, 2025 ($15,650 per year). Id. Individuals may also be found eligible for BCP if their annual income is reasonably expected to be under 100% FPL even if their income in particular months exceeds 100% FPL. See BCPH §16.9.
Individuals must verify income when applying for BCP benefits and when there is a change in circumstance that affects eligibility or benefit level. Wis. Admin. Code § DHS 102.03(3)(a) and BCPH §9.9.6. If an individual “is able to produce required verifications but refuses or fails to do so”, the benefits will be denied or terminated. Wis. Admin. Code § DHS 102.03(1). Program policy requires the agency to “[a]dvise the applicant of the specific verification required.” BCPH §9.2. In the event an individual fails to produce verification within specified timeframes after receiving an “adequate notice of the verification required” and if the requested verification is required to determine current eligibility, the agency may deny or terminate benefits. BCPH §9.11.4; See also, Wis. Admin. Code § 102.03(1).
In this case, the agency ended Petitioner’s BCP after he reported that he had begun working for — because the agency concluded that he had failed to provide adequate proof of his income and expenses even though Petitioner provided invoices showing that he had earned $100 in August 2024 and just a little more than that in September 2024 as well as a statement from — confirming that Petitioner performed work only on an “as needed” basis. The agency representative contended that because the income was contract pay rather than wages, Petitioner had to submit self-employment report forms. The agency’s written verification requests did not, however, say that he must submit a SEIRF; one of those requests indicated that SEIRFs were an example of what could be used to comply with the agency’s request. SEIRFs, however, are much better suited for gathering information about more traditional types of self-employment that have associated expenses (i.e., rental businesses, construction businesses). Petitioner’s work, as a 21 year old student for —, on an as needed, very limited basis did not have associated expenses. He thus had nothing requiring verification.
Petitioner made a good-faith effort to comply with the agency’s verification requests regarding contract or “self-employment income” by submitting both the letter from — and the invoice of the minimal pay he received on the two days he worked there. Given Petitioner’s efforts to comply and the fact that the traditional form for gathering information regarding self-employment income was not a good match for this circumstance, the agency should have reached out to Petitioner to clarify that they were seeking information regarding his expenses and/or to know whether his income would be ongoing. Had the agency done so, it would have discovered that Petitioner had in fact provided all the documentation available about his unpredictable, limited work for —.
Moreover, the evidence in the record established that Petitioner’s income from — did not exceed the BCP income limit in November 2024 or December 2024, even in combination with the work study income from — that he began to earn after the agency ended his benefits on November 1, 2024.
For the reasons set forth above, I am remanding this matter to the agency to approve Petitioner for BCP as of November 1, 2024.
Conclusions of Law
Because Petitioner did not receive adequate notice of the verification required and because Petitioner’s income remained under the BCP as of November 1, 2024, his BCP was not correctly terminated.
THEREFORE, it is
Ordered
That the matter is remanded to the agency to: (1) approve Petitioner for BadgerCare Plus effective November 1, 2024, and (2) send Petitioner written notice that it has done so. These steps must be taken within ten days from the date of this decision.
[Request for a rehearing and appeal to court instructions omitted.]
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