(1) An agency shall
enter into a written, signed subsidized guardianship agreement with a
prospective guardian before guardianship is established under s.
48.977,
Stats., or under a substantially similar Wisconsin tribal law and an agreement
specified in s.
DCF
55.01(2), and before providing
subsidized guardianship payments to the guardian. The agency shall provide the
prospective guardian with a copy of the signed agreement.
(2) The subsidized guardianship agreement
shall be on a form prescribed by the department and specify all of the
following:
(a) The amount of the monthly
subsidized guardianship payments that will be provided under the
agreement.
(b) The manner in which
subsidized guardianship payments may be adjusted periodically based on the
circumstances of the guardian and needs of the child, in consultation with the
guardian.
(c) A description of any
additional services and assistance that the child or guardian will be eligible
for under the agreement and the procedures by which the guardian may apply for
the additional services and assistance as needed.
(d) That the agency will pay or reimburse the
total cost of nonrecurring expenses directly related to obtaining guardianship
of the child, not to exceed $2,000, including court costs, attorney fees, and
other reasonable and necessary expenses.
(e) That the agreement will remain in effect
without regard to the state of residence of the guardian.
(f) That medical assistance provided under
Title XIX of the Social Security Act of 1935, as amended, is available to the
child as follows:
1. Medical assistance will
be provided in accordance with the procedures of the state in which the child
resides, except if a child receiving subsidized guardianship payments from an
agency in Wisconsin is not eligible for medical assistance in the child's state
of residence, the child is eligible for Wisconsin's medical assistance program
under ss.
49.43 to
49.497,
Stats.
2. Medical assistance may
not be used as primary insurance coverage for care of a child that is covered
by a guardian's private health insurance. A prospective guardian shall complete
a form prescribed by the department of health services to provide information
on any private health insurance coverage before guardianship is established
under s.
48.977,
Stats., or a substantially similar Wisconsin tribal law.
Note: Form HCF-10115, BadgerCare
Plus/Medicaid Health Insurance Information, is available in the forms
section of the Department of Health Services website,
http://www.dhs.wisconsin.gov,
or from the Division of Health Care Access and Accountability, P.O. Box 309
Madison, WI 53701-0309.
(g) The agency's responsibility to release
medical, educational, and other historical information the agency has about the
child to the prospective guardian, in accordance with applicable law.
(h) That if any of the following occur, the
guardian shall notify the agency within 10 calendar days of the effective date:
1. The guardian's address changes.
2. There is a change in the child's
guardian.
3. The child enters the
military.
4. The child gets
married.
5. The child is no longer
living in the home of the guardian.
6. The child is deceased.
7. The child completes high school or an
equivalent educational program after reaching 18 years of age.
8. If the child is covered by the guardian's
health insurance and the guardian's health insurance benefits change or if the
child was not covered by the guardian's health insurance and becomes
covered.
9. The guardian is no
longer supporting the child or is no longer legally responsible for supporting
the child.
10. The child is placed
outside the guardian's home at public expense.
11. The child's parent is residing with the
guardian.
(i) The
guardian's responsibility to complete and return to the agency the annual
review questionnaire under s.
DCF
55.10(3) in a timely manner to allow
the agency to determine whether the child and guardian remain eligible for
subsidized guardianship payments.
(j) A description of the terms upon which the
subsidized guardianship agreement may terminate under s.
DCF
55.10(5) (bm) 2.
(k) That an agency may recover any
overpayment of subsidized guardianship payments from a current or former
guardian by any legal means as determined by the agency. An overpayment to a
guardian who continues to receive subsidized guardianship payments may be
recovered by reducing the amount of the person's monthly payment.
(L) That the guardian may be eligible for
adoption assistance under s.
48.975,
Stats., and
42 USC
673 for care of the child if the guardian
later decides to adopt the child. In determining eligibility for adoption
assistance, the placement of the child in the home of the guardian and any
subsidized guardianship payments will be considered to have never been
made.
(m) That the guardian may
name a prospective successor guardian of the child to assume the duty and
authority of guardianship upon the death or incapacity of the guardian. The
prospective successor guardian would be eligible for monthly subsidized
guardianship payments only if the conditions specified in s.
48.623(6)
(bm), Stats., and s.
DCF 55.125 are
met and the court appoints the successor guardian to assume the duty and
authority of guardianship under s.
48.977(5m),
Stats., or under a substantially similar Wisconsin tribal law and an agreement
specified in s.
DCF
55.01(2).
(3) An agency shall use a form prescribed by
the department to amend a subsidized guardianship agreement with a guardian to
include a prospective successor guardian.
Note: Form DCF-F-CFS2365, Subsidized
Guardianship Agreement, is available in eWiSACWIS, the child welfare
automation system, or by writing to the Division of Safety and Permanence, P.O.
Box 8916, Madison WI 53708-8916.
Form DCF-F-5038-E, Amended Subsidized Guardianship
Agreement to Include Successor Guardian, is available in the forms section of
the department website, http://dcf.wisconsin.gov, or by writing to the Division
of Safety and Permanence, P.O. Box 8916, Madison, WI
53708-8916.