41.2 BadgerCare Plus Prenatal Program Eligibility Requirements

Pregnant women (or when applicable, their assistance group), must meet the following BadgerCare Plus eligibility requirements to qualify for the BadgerCare Plus Prenatal Program:

The applicant’s net countable income must not exceed 300% of the FPL (under non-MAGIApply to households whose eligibility is determined using BadgerCare Plus relationship rules (prior to March 31, 2014) to budget income for a household prior to transitioning to MAGI BadgerCare Plus budgeting rules. rules) or 306% of the FPL (under MAGIModified Adjusted Gross Income. MAGI rules are used to determine BadgerCare Plus eligibility for new applicants beginning in 2014 and for existing members as of March 31, 2014, or their next regularly scheduled renewal, whichever is later. MAGI rules are based on tax relationships and family relationships, and they consider taxable income and whether children and tax dependents are required to file. rules).
The applicantA request for BadgerCare Plus coverage. The request must be on the Department's or Federally-facilitated Marketplace’s application, registration form or account transfer (from Federally-facilitated Marketplace) and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. must not have current or past access to an employer’s health insurance benefit where the employer pays 80% or more of the premium cost or to any State of Wisconsin health insurance plan.
The applicant must provide any required verifications.

Note: For eligibility beginning on or after January 1, 2014, pregnancy will only be verified if the worker has information that contradicts the applicant’s self-declared information.

The applicant must not have health insurance coverage (Chapter 7) through any HIPAA standard plan now or in the three calendar months prior to the BadgerCare Plus Prenatal request.

41.2.1 Unique Aspects of BadgerCare Plus Prenatal Program

Providing an SSNSocial Security number is not an eligibility requirement for either inmates or non-qualifying immigrants applying for the BadgerCare Plus Prenatal Program.
Cooperation with Child Support Enforcement is not an eligibility requirement for this program.

Unlike regular BadgerCare Plus which locks in eligibility throughout the pregnancy, BadgerCare Plus Prenatal Program eligibility may be terminated with timely notice for failure to meet any of the BadgerCare Plus eligibility requirements listed in 41.1.
There is no Presumptive Eligibility for the BadgerCare Plus Prenatal Program. Eligibility for the BadgerCare Plus Prenatal Program may only be determined by the IM agencies.
There is no 3-month backdating option available for Prenatal Program members.
Unlike BadgerCare Plus for Pregnant Women, Prenatal Program members are not eligible for the 60-day pregnancy extension, but are eligible for Emergency Services during that time.

This page last updated in Release Number: 13-02

Release Date: 10/25/13

Effective Date: 10/01/13