1. Wisconsin Chronic Disease Program and Estate Recovery
Matt Fanale and Jennifer Wickey
Wisconsin Department of
Health Services
Division of Health Care
Access and Accountability
August 12, 2014
Wisconsin Department of Health Services

2. Agenda Overview of WCDP How to apply for WCDP
How to become a WCDP Provider
Overview of Estate Recovery Program
What governs the changes to the Estate Recovery Program
What are the changes to the Estate Recovery Program
Questions
Protecting and promoting the health and safety of the people of Wisconsin

3. What is the Wisconsin Chronic Disease Program?
WCDP is an all state tax dollar program helping pay for services for citizens with Chronic Renal Disease, Adult Cystic Fibrosis, and Hemophilia. It is a part of ForwardHealth.
WCDP is the payer of last resort over other insurance sources.
Protecting and promoting the health and safety of the people of Wisconsin

4. Who qualifies for WCDP?
Eligibility is based on Wisconsin residency and diagnosis of Chronic Kidney Disease, Adult Cystic Fibrosis, or Hemophilia.
You cannot be denied based on income.
Co-insurance and deductibles are based on income and family size.
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5. What is covered?
Renal
Inpatient and outpatient dialysis and transplant services.
One pre-transplant dental exam.
Certain prescriptions, supplies, lab, and x-ray services.
Transplants are not covered.
Protecting and promoting the health and safety of the people of Wisconsin

6. Renal program requirements
You must apply through Wisconsin Medicaid/BadgerCare.
To be enrolled in the WCDP renal program you must be enrolled in Medicare Parts B and D.
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7. How to apply?
Applications are available on the ForwardHealth website under the Related Programs and Services section, or by calling
If you are not already on Medicaid, BadgerCare, or SeniorCare you can work with your social worker to fill out the application and forms.
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8. What is needed for program consideration?
The completed application, with all forms for each program, including:
Information on other insurance.
Financial information for the previous year.
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9. How to determine is the application has been approved?
If the member is not already in BadgerCare they will receive a new ForwardHealth card.
If a member isn’t sure if they’re on the program they can call Member Services at to verify enrollment.
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10. How long can an applicant stay on WCDP?
As long as you still qualify.
Reasons for Ineligibility
Move out of Wisconsin.
Failure to complete annual membership recertification.
No longer have the disease.
Protecting and promoting the health and safety of the people of Wisconsin

11. How to become a WCDP provider
Any provider that wishes to have provide WCDP services must call and request a certification packet. Questions regarding members or claims can be directed to this same number.
This is a separate certification from BadgerCare.
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12. How Does WCDP Decide What Pharmacy is Allowed?
Any manufacturer wishing to supply pharmacy to WCDP members must sign a Manufacturer’s Rebate Agreement. This agreement is different from the BadgerCare rebate agreements.
WCDP only adds manufacturers with products relevant to the program.
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13. Questions on WCDP
Matt Fanale Medicaid Program and Policy Analyst
Protecting and promoting the health and safety of the people of Wisconsin

14. What is Estate Recovery
The Wisconsin Medicaid Estate Recovery Program seeks repayment for the cost of certain long-term care services paid for by Medicaid and BadgerCare Plus on behalf of members and all services received by the Wisconsin Chronic Disease Program (WCDP) members.
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15. How does the Department recover benefits?
Certain non-probate assets;
The estates of members; and
Liens placed on their homes.
The funds recovered are returned to the Wisconsin Medicaid program, where they benefit other members.
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Protecting and promoting the health and safety of the people of Wisconsin

16. Estate Recovery Authority
Authorized by Social Security Act, Title XIX, Sec. 1917
Authorized by Wis. Stat § , and
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17. How and when will a claim be paid?
The Department’s claim should be paid by the attorney/personal representative of the estate in accordance with § , Wis. Stats.
Higher priority claims paid before the Department are:
The cost of administering the estate.
The reasonable funeral and burial costs.
Costs of the last illness that were not paid by Medicaid (should not be any except in unusual circumstances).
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Protecting and promoting the health and safety of the people of Wisconsin

18. When will the Department’s claim not be paid or delayed?
The Department’s claim will not be paid from cash assets if there are any of the following:
A surviving spouse;
A disabled or blind child of any age; or
A child under age 21
If there is a surviving spouse, disabled, blind or minor child, and there is ownership interest in a home in the estate, then the Department will impose a lien on the home. This lien will not be enforced while any of the above are living.
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Protecting and promoting the health and safety of the people of Wisconsin

19. What if the estate is unable to repay Medicaid?
The legal process known as probate settles an individual’s solely owned property by distributing the estate to creditors, heirs, and beneficiaries.
Creditors file claims in estates to ensure payment of a debt owed them.
The Department is paid before most other creditors. Both the Department and other creditors are paid before any assets are distributed to heirs or beneficiaries whether or not there is a will.
Recovery will also be made from the member’s non-probate assets, including joint property interests, marital property interests, life estates, revocable trusts, real estate by transfer on death deed, and the proceeds of life insurance policies and annuities.
If there are insufficient assets in the estate to pay the Department’s claim, the Department is paid what is available and the recovery is ended.
06/2014
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20. Exemptions to Recovery (Hardships)
There are standards (DHS (12), Wis. Admin. Code) for determining whether the Department’s recovery would result in an undue hardship for an heir, beneficiary or co-owner.
An heir, beneficiary or co-owner may apply for a waiver of the Department’s claim on their portion of the estate or property for one of the following reasons:
The heir, beneficiary, or co-owner would become or remain eligible for Supplemental Security Income (SSI), FoodShare program, Temporary Assistance for Needy Families (TANF), or Medicaid, if the state pursued its claim.
The deceased’s estate or property contains real estate used as part of the heir, beneficiary’s or co-owner’s business, which may be, but is not limited to, a working farm, and recovery by the Department would affect the property and would result in the heir or beneficiary losing his or her means of a livelihood .
The heir, beneficiary, or co-owner is receiving general relief or veterans benefits based on need under § (1m), Wis. Stats.
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21. Hardships Cont.
The person handling the estate will be notified of these rights and how to apply for a hardship when the estate is being probated through a court or through an affidavit process.
That individual is responsible for notifying the heirs, beneficiaries, or co-owners of these rights. An heir, beneficiary or co-owner can apply to the Department for a waiver of the recovery of his or her portion of the estate or property.
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22. Why the changes?
In the State Budget, also referred to as Act 20, made changes to the Estate Recovery Program to ensure the long-term financial sustainability of the Medicaid program. Under Act 20, the Department was given the necessary tools to collect the health care costs that were funded by taxpayers from the estates of former Medicaid beneficiaries.
In September 2013, the Wisconsin Legislature’s Joint Committee on Finance approved the implementation of most of the changes.
On December 14, 2013, Wisconsin Act 92 modified the Estate Recovery Program provisions included in Act 20 to codify the action taken by the Joint Committee on Finance.
06/2014
Protecting and promoting the health and safety of the people of Wisconsin

23. Changes based on Act 20 Recovery from life estates
Recovery from joint property
Recovery from non-probate property
Recovery from TEFRA liens
Recovery from the estate of surviving spouses
Recovery from revocable trusts (living trusts)
Recovery from life insurance policies
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24. Members affected by these changes
Medicaid members of any age who live in nursing homes.
Medicaid members of any age living in an inpatient hospital and are required to contribute to their cost of care.
Medicaid members age 55 or older may have the cost recovered for only certain benefits received while they live in the community.
Medicaid members age 55 or older who reside in the community and receive services through a home and community-based waiver program, or through the Program of All-Inclusive Care for the Elderly (PACE).
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25. Affected members (cont.)
Wisconsin Chronic Disease Program (WCDP) participants of any age for services that were provided on or after September 1, 1995.
Community Options Program (COP) participants who are age 55 or older for services that were provided on or after January 1, 1996, and
Non-Medicaid Family Care services provided on or after February 1, 2000, as reported to the Department for enrollees age 55 or older and living in the community; or that are any age and who live in an inpatient hospital and are required to contribute to their cost of care; or who live in a nursing home.
06/2014
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26. Notification to those affected
Medicaid and WCDP members, and members who were considered institutionalized were mailed a letter in late June informing them of the changes effective August 1, 2014.
The letter is available on the Estate Recovery Program website at dhs.wisconsin.gov/medicaid/erp
New members will be made aware of the program rules when they enroll in Medicaid and reach the age of 55 or become institutionalized members and will receive the Estate Recovery Program handbook.
06/2014
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27. What is a life estate?
A life estate is created when a property holder transfers ownership of the property to someone else (remainderer) and retains the right to reside in, and benefit from the real estate, such as receiving rent.
The life tenant’s percentage interest is determined using the life expectancy tables at the time the life estate is created.
The rest of the interest is owned by the remainderer (for example a child or children).
When the life tenant dies, the entire property interest passes to the remainderer.
06/2014
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28. Life Estate Prior to August 1, 2014 Effective August 1, 2014
Estate Recovery did not pursue recovery from life estates.
Effective August 1, 2014
The Department will recover only the life tenant’s interest remaining at the time of death of life estates created on or after August 1, 2014.
06/2014
Protecting and promoting the health and safety of the people of Wisconsin

29. What are joint property deeds?
Joint tenancy
Under joint tenancy, if two people take title of the property as joint tenants on a deed, each person has a 100 percent ownership of that piece of property.
Regardless of the number of joint tenants on a deed, each tenant has equal ownership rights and interest.
When one joint tenant dies, the surviving tenants automatically own the property.
Joint tenancy automatically gives each tenant a “right of survivorship” where the surviving tenants receive 100% of the property.
When only one joint tenant is left alive, he or she receives the entire estate and the joint tenancy is dissolved.
06/2014
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30. Joint property deeds cont.
Tenancy in common
Tenancy in common provides for multiple percentages of ownership interest and inheritance rights for the heirs of each tenant.
Unlike joint tenancy, tenancy in common grants no “right of survivorship.” Thus, no other tenant in common is entitled to receive a share of the property upon a tenant in common’s death; instead, the property becomes part of the deceased’s estate.
06/2014
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31. Joint Property Deeds Prior to August 1, 2014 Effective August 1, 2014
Only joint accounts at financial institutions were recovered.
Effective August 1, 2014
All joint property and joint property deeds created on or after August 1, 2014 will be subject to recovery.
06/2014
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32. Non-probate property
Property that is held in joint tenancy or as tenants by the entirety.
Bank or brokerage accounts held in joint tenancy or with payable on death (POD) or transfer on death (TOD) beneficiaries.
Property held in a trust.
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33. Non-probate property Prior to August 1, 2014 Effective August 1, 2014
Only POD accounts at a financial institution were recovered.
Effective August 1, 2014
Recovery will be made from all non-probate assets for any member who passes away on or after August 1, 2014.
06/2014
Protecting and promoting the health and safety of the people of Wisconsin

34. TEFRA Liens Estate recovery uses two types of liens: TEFRA Liens
Must follow rules set out in the federal Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982;
Pre-death liens are imposed on the homes of living Medicaid recipients determined to be permanently institutionalized and not likely to return home to live.
Post-death liens which are often part of the probate process.
06/2014
Protecting and promoting the health and safety of the people of Wisconsin

35. TEFRA Liens Prior to August 1, 2014 Effective August 1, 2014
Estate Recovery did not pursue TEFRA liens on life estates.
Effective August 1, 2014
Estate Recovery will now pursue recovery through TEFRA liens placed on life estates created on or after August 1, 2014.
06/2014
Protecting and promoting the health and safety of the people of Wisconsin

36. Surviving Spouse’s Estate (Marital Property)
Property acquired by either spouse during the course of a marriage is considered marital property.
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37. Surviving Spouse’s Estate
Prior to August 1, 2014
Recovery has not been sought from a surviving spouse’s estate since 1995.
Effective August 1, 2014
Consistent with Wis. Stat. § 766.31, recovery will now be pursued from 50% of the surviving spouse’s estate.
06/2014
Protecting and promoting the health and safety of the people of Wisconsin

38. Revocable Trusts (living trusts)
A revocable trust is a trust created by an individual who wants the ability to change the terms of their trust. Assets in the trust are considered the individual’s personal assets for Medicaid planning purposes.
06/2014
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39. Revocable Trusts (living trusts)
Prior to August 1, 2014
The authority for Estate Recovery to recover from revocable trusts ( “living trusts”) was unclear.
Effective August 1, 2014
Since Act 92 specifically granted this authority, Estate Recovery will now pursue recovery from only those revocable trusts created on or after August 1, 2014.
Recovery cannot be made from irrevocable trusts, with the exception of those assigned to a funeral home, SNT, and pooled trusts.
06/2014
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40. Life Insurance Prior to August 1, 2014
Recovery was made only from policies designating the estate as the beneficiary or if the beneficiary pre-deceased the insured.
Effective August 1, 2014
Recovery will be made from all life insurance policies created on or after August 1, 2014, regardless of the beneficiary.
06/2014
Protecting and promoting the health and safety of the people of Wisconsin

41. Questions on Estate Recovery
Wisconsin Estate Recovery Program or
Jennifer Wickey
Estate Recovery Section Chief
Protecting and promoting the health and safety of the people of Wisconsin