14-01 Version of 2.3 BadgerCare Plus Test Group
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State of Wisconsin
Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

2.3 BadgerCare Plus Test Group

2.3.1 The non-MAGI BadgerCare Plus Test Group

2.3.1.1 Parents and Caretaker Relatives

2.3.1.2 Essential Person

2.3.1.3 Pregnant Women

2.3.1.4 Children

2.3.1.5 Childless Adults

2.3.2 MAGI Test Group

2.3.2.1 Forming the Test Group Using MAGI Tax Filing Rules

2.3.2.2 Forming the Test Group Using MAGI Relationship Rules

2.3.2.3 MAGI Flowchart

2.3.3 Applying non-MAGI Rules vs. MAGI Rules

2.3.4 Former Foster Care Youth (FFCY) Eligibility  

 

The following sections outline how to form BadgerCare Plus test groups under the 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 and the new 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. See 2.3.3 Applying non-MAGI Rules vs. MAGI Rules for more information about when to apply non-MAGI rules and when to apply MAGI rules to a case.

2.3.1 The non-MAGI Test Group

For BadgerCare Plus members whose eligibility is determined using non-MAGI  budgeting rules, workers should use the following methodology to determine who should be included in the member’s household and whose income in that household should be counted.

 

The non-MAGI BadgerCare Plus Test Group he primary person and any individuals living in his or her household whose income and/or needs are considered when determining financial eligibility. Inclusion in the Test Group is determined by qualifying relationships and legal responsibility.includes the primary person and any individuals living in his or her household whose income and/or needs are considered when determining financial eligibility. Inclusion in the Test Group is determined by qualifying relationships and legal responsibility.

 

Anyone in the home who meets the criteria of being in the BadgerCare Plus Test Group is always included in the group whether or not he or she requested BadgerCare Plus.

 

Persons in the home who do not meet the criteria to be in a BadgerCare Plus Test Group must be excluded. However, they may be included in a BadgerCare Plus Test Group in another case.

 

The primary person who applies for BadgerCare Plus must meet one of the following requirements in order to form a BadgerCare Plus Test Group. The primary person must either be:

 

  1. A parent residing with his or her child under age 19 or residing with a spouse and his or her child who is under age 19.

  2. A caretaker relative residing with a child in the home who is under age 19, or an individual residing with a spouse who is a caretaker relative  of a child in the home who is under age 19,

  3. A pregnant woman, or the spouse of a pregnant woman,

  4. A Youth under age 26 who was in out-of-home care (e.g., foster care) at age 18, or

  5. A child under age 19.

2.3.1.1 Parents and Caretaker Relatives

The BadgerCare Plus Test Group for a primary person who is residing with his or her own child or with a spouse and the spouse’s child will include the following individuals:

 

  1. The primary person and the primary person’s spouse.

  2. A child under age 19 of the primary person or the primary person’s spouse.

  3. A co-parent of a primary person’s child or the co-parent of the spouse’s child.

  4. Any spouse of a co-parent.

  5. Any child under age 19 of a co-parent.

  6. The other parent of a co-parent’s child.

  7. A child of the primary person’s child or the spouse’s child.

  8. The spouse of an included child, if that child is a parent, or the spouse is under age 19.

  9. The co-parent of an included grandchild.

  10. A child under age 19 who is a qualified relative of, and who is residing with, the primary person, the primary person’s spouse or another included adult, and

  11. An essential person (2.3.1.2)

 

If the primary person is a caretaker relative of a child under age 19 or the spouse of a caretaker relative of a child under age 19, the BadgerCare Plus Test Group will include the following individuals:

 

  1. The caretaker relative,

  2. The caretaker relative's spouse,

  3. The child under age 19 who is under the care of the caretaker relative,

  4. A parent of the child, if the caretaker relative has legal custody of the child, and

  5. Any essential person (2.3.1.2).

 

A parent residing with his or her child under the age of 19 must be in the same BadgerCare Plus Test Group. This is true even when the legal custody of the child has been transferred to someone living outside of the home. The only exception is when someone’s parental rights have been legally terminated. See Chapter 10 for more information on Child Welfare Parents.

 

When an eligible child moves from the home of a parent or caretaker relative to the home of another caretaker relative or caretaker relative who applies for BadgerCare Plus in the same month, the new caretaker relative can be eligible as of the applicationA request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. date. The child, however, isn't eligible in the new household until the 1st of the month after his or her eligibility ends on the previous case.

 

Joint Placement

In determining eligibility for the parents with equivalent placement, the child is considered to be residing in both of their homes. That means the child will be included in the group size for both cases and the child’s income will also be counted in both cases. See 2.2.1.2

2.3.1.2 Essential Person

Note: This policy ends as of March 31, 2014.

 

To be included in a BadgerCare Plus test group as an essential person, the designated person must:

 

  1. Be related to a BadgerCare Plus test group member, and

  1. Be otherwise nonfinancially eligible, and

  

Provide at least one of the following to another BadgerCare Plus member:

    1. Child care that enables a caretaker relative to:

      • Work outside the home, full time (30 hours or more a week), for pay,

      •  Receive training full time (30 hours or more a week),

      • Attend HS or GED classes full time (as defined by the school).

       

    1. Care for anyone who is incapacitated.

     

Consider a caretaker relative incapacitated if, due to physical, emotional, or mental impairment, he or she cannot:

      • Work full - time at employment paying at least Federal minimum wage, or

      • Perform customary, necessary homemaking activities or provide adequate care for his or her children without help from other persons.

 

Only IM agency staff in positions or with authority higher than a first line IM Worker may approve, deny, and review any essential person designation. The essential person designation must be reviewed at least every six months.

 

Only a caretaker relative who has a child under his or her care may designate an essential person.

 

To designate an essential person, the caretaker relative must submit a Designation of a BadgerCare Plus Essential Person form to the IM agency. He or she must document the need for each essential person and that the person can provide the essential service.

 

More than one person may be designated as an essential person in the same BadgerCare Plus group, but only for different children.  No one, however, may be an essential person in more than one BadgerCare Plus group. Also, there can be no essential person if there is no born child, as in a Maternity Care case.

2.3.1.3 Pregnant Women

If the primary person is:
 

 

the BadgerCare Plus Test Group will include the pregnant woman and her spouse.

 

If the pregnant woman is under 19 and residing with a parent or caretaker, the parent or caretaker would be the primary person and the BadgerCare Plus Test Group would be built around the parent or caretaker.

 

Also include in the BadgerCare Plus Test Group size each fetus the pregnant woman is carrying. Verification of the number of fetuses is not required unless questionable.  If the number of fetuses is unknown, add 1 to the group size. If verification is required but there is no verification on the number of fetuses, add 1 to the group size.

2.3.1.4 Children

If the primary person is a child under age 19, is not a parent or a caretaker relative of a child in the home, and is not residing with a parent or caretaker relative, the BadgerCare Plus group consists solely of the child and his or her spouse if they are residing together. In this situation, the spouse of the child under 19 is not eligible for BadgerCare Plus unless he or she is also under age 19 or there are other children in the household under the care of either the child who is the primary person or the spouse.

2.3.1.5 Childless Adults

Prior to April 1, 2014, childless adults will only be eligible for coverage under the BadgerCare Plus Core Plan. The Core Plan assistance group only consists of the childless adult and his or her spouse, if the member was married at the time of application.

2.3.2 MAGI Test Group

Beginning February 1, 2014, BadgerCare Plus eligibility determinations will use Modified Adjusted Gross Income (MAGI) rules. MAGI rules are based on the concept of an individual’s tax household, not necessarily on the physical household or family relationships.  

 

Note: Whether or not someone is a tax filer or is a dependent of a tax filer is based on what the individual plans to do for the current calendar year’s taxes, not on what he or she is required to do based on IRS tax law. For example, many individuals file taxes even though they are under the filing threshold because they want to receive their full tax refund or to qualify for the Earned Income Tax Credit.  If a member reports that they plan to file taxes, we will treat them as a tax filer in the test group, even if they are below the threshold for being required to file.

 

All new applicants with a filing date on or after February 1, 2014 will be tested only using MAGI rules. Ongoing beneficiaries will transition to MAGI rules at their next scheduled renewal or April 1, 2014, whichever is later.

 

An ongoing beneficiary is someone who:

 

 

Note: Ongoing cases that had a renewal in January or February of 2014 will transition to MAGI rules the next time eligibility is run by the worker for the month of April 2014 or later.

2.3.2.1 Forming the Test Group using MAGI Tax Filing Rules

All MAGI groups are based on a “target” individual. Each person who can become eligible for BadgerCare Plus on the application will be a target during the eligibility determination for a case.

 

Tax Filers

If the individual is a tax filer and is NOT being claimed as a dependent by anyone else, then the individual’s MAGI group consists of the tax filer, the tax filer’s spouse, and any dependents the tax filer is claiming.

 

Out-of-the-Home Tax Dependents

A tax filer is able to claim individuals who live outside of their home as their tax dependents. Common examples include college students and other adult children, elderly parents, or siblings who do not live with the filer(s). Tax filers can also claim a deceased child as his or her tax dependent in the year that the child has died. In these instances, the deceased child would be included in the tax filer’s group size, though the child would not be eligible for benefits on that application.

 

Deceased Co-Filers

It is possible for an individual to file his or her taxes jointly with a deceased spouse for the taxable year in which the spouse died. However, unlike deceased tax dependents, they will not be included as a household member.

 

Household Members in the Military

Deployed military members are still considered part of a tax household. Under MAGI rules, the military member’s taxable income will count in the household, and he or she will also be included in the household’s group size, as appropriate. If a household member is absent due to military activity, he or she may be included in the group size, but will not be eligible for assistance on this case.

 

Married Couples

Married individuals who are living together are always included in each other’s group size, even if they are filing taxes separately. If a married couple is living apart but filing jointly, the couple is included in each other’s group size. If the married couple is living apart and filing taxes separately, or are not planning to file taxes, do not include them in each other’s group size.

 

Tax Dependents

In general, a tax dependent’s household will be the same as his or her tax filer’s household, even if the tax dependent is also a tax filer.

 

However, if any of the following situations apply, then the tax dependent's eligibility is based on MAGI relationship rules:

 

  1. The individual is being claimed as a dependent by a parent outside of the home (a non-custodial parent is defined as a parent who is living apart from the parent applying for benefits for the child),

  1. The individual is being claimed as a dependent by someone who is not their parent; or
  2. The individual lives with both parents and his or her parents are not married filing jointly.

2.3.2.2 Forming the Test Group Using MAGI Relationship Rules

Individuals who meet one of the exceptions to the MAGI tax filing rules or who are not tax filers or tax dependents will have their eligibility determined using MAGI relationship rules.

 

Under relationship rules, only include individuals who are living in the home with the target. If the target individual is under 19, then the target’s group includes the target’s parents, the target’s spouse, the target’s siblings under age 19 (including step and half siblings), and the target’s children.

 

If the target individual is over age 19, the target’s group includes the target’s spouse and the target’s children under age 19.

2.3.2.3 MAGI Flowchart

The following flowchart may assist workers in forming groups under MAGI rules.

 

 

2.3.3 Applying non-MAGI Rules vs. MAGI Rules

Applications Submitted to the Department of Health Services

Individuals who apply for BadgerCare Plus prior to February 1, 2014 will have their eligibility determined using 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. These individuals will continue to be subject to non-MAGI rules until March 31, 2014 or their next regularly scheduled 2014 renewal, whichever comes later.

 

If an individual with eligibility under non-MAGI rules reports a change that makes them ineligible for BadgerCare Plus, MAGI information will be collected and their eligibility re-run under MAGI rules in order to determine if the individual may still be eligible for BadgerCare Plus.

 

Individuals who apply for BadgerCare Plus coverage on or after February 1, 2014 will have their eligibility determined under MAGI rules. If they request backdated eligibility for a month prior to February 2014, we will use non-MAGI rules for those months.

 

Applications Submitted to the Federally-facilitated Marketplace

Beginning October 1, 2013, individuals can submit applications for Medicaid or CHIP coverage to the federally-facilitated marketplace (the Marketplace). If the Marketplace determines or assesses individuals as eligible for coverage through BadgerCare Plus or EBD Medicaid, the account will be transferred to Wisconsin.

 

The filing date for applications received from the Marketplace is the date the application was submitted to the Marketplace. The 30 day processing time frame begins on the date the application is submitted to the IM agency’s inbox.

 

Effective February 1, 2014, DHS will send accounts of applicants and members found ineligible for BadgerCare Plus to the Marketplace for a determination of advanced premium tax credits and cost-sharing reductions.  

2.3.4 Former Foster Care Youth Eligibility

Former Foster Care Youth are categorically eligible for BadgerCare Plus.

 

Through December 31, 2013, if the primary person is:

 

 

then the BadgerCare Plus test group will include the youth and his or her spouse if the spouse is also a former foster care youth.

 

Beginning January 1, 2014, if the primary person is:

 

then the BadgerCare Plus group will include the youth and his or her spouse if the spouse is also a former foster care youth.

 

 

 

This page last updated in Release Number: 14-01

Release Date: 02/07/14

Effective Date: 02/01/14

The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Publication Number: P-10171