43.2 Core Plan Eligibility Criteria

In order to enroll in the Core Plan, an individual must meet all of the following criteria:

Income

Age

Dependents

Does not have any children under age 19 under his/her care (2.2).
Is not pregnant. Exception: a Core Plan member who becomes pregnant remains enrolled in the Core Plan until she has provided pregnancy verification and becomes eligible for the BadgerCare Plus Standard or Benchmark Plan.

Citizenship/Identity

Must provide verification, including documentation, of US citizenship or qualifying immigrant status (4.2) and social security number (or proof of application for a SSN ) (9.9.1)

Residency

Other Programs

Is ineligible for the BadgerCare Plus Standard or Benchmark plan, or any full benefit Medicaid plan
Is not entitled to Medicare.
Is not disabled. Exception: a disabled individual who is not yet entitled to Medicare benefits can be enrolled in the Core Plan if s/he has an unmet EBD Medicaid deductible or was determined ineligible for EBD Medicaid due to excess assets.
Individuals can be dually enrolled in the Core Plan and Family Planning Only Services and Tuberculosis (TB) Medicaid but cannot be entitled to Medicare benefits under any part.

Health Insurance

Does not have access to health insurance through a current employer in the month of application or subsequent three months, regardless of the amount of employer contribution toward the premium.
Did not have access to health insurance through a current employer in the past 12 months, regardless of the amount of employer contribution toward the premium, unless there is a good cause reason for not signing up.
Is not currently covered by a health insurance policy (through employer or individual policy).
Has not been covered by a health insurance policy for the past 12 months, unless individual has a good cause reason for losing the coverage.

Application requirements

Must complete a health needs assessment at application and annual renewal;
Must pay a non-refundable, annual application fee. The fee is waived for homeless individuals. ”Homeless” is defined according to HUD standards ( See 43.4.2.1 Waiver of Application Fee )
To remain enrolled in the Core Plan, individuals must obtain a comprehensive physical exam within the first 12 month certification period, unless there is a good cause reason for not doing so.
Must pay required monthly premiums (see 43.7.3)

Married couples apply with one application and pay one annual non-refundable renewal fee.

This page last updated in Release Number: 12-02

Release Date: 10/05/12

Effective Date: 07/01/12