8.1 Pregnant Women

Note: This chapter does not apply to pregnant women in the BadgerCare Plus Prenatal Program.

A pregnant woman who is enrolled in BadgerCare Plus stays eligible for:

The balance of the pregnancy, and
An additional 60 days after the last day of pregnancy through the end of the month in which the 60th day occurs.

The decision about her eligibility need not to be made prior to termination of pregnancy, but 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. must be filed before the end of the pregnancy in order for her to remain enrolled as a pregnant woman for the 60 days after the pregnancy ends. If the application is not filed before the end of the pregnancy and the newborn is living with her or she is the caretaker relative of other children under 19, she should be tested as a caretaker relative once the pregnancy ends. An application for Express Enrollment does not meet this application test.

If a pregnant woman is covered under the Standard Plan at any time during her pregnancy she will remain in the Standard Plan while she is eligible as a pregnant woman, regardless of changes in income or other eligibility factors. As of April 1, 2014, every pregnant woman in BadgerCare Plus will be enrolled in the Standard Plan, including someone who has become eligible by meeting a deductible. After February 1, 2014 pregnant women will be enrolled in the Standard Plan once she has been found eligible for Badgercare Plus. Pregnant women who are enrolled in the Benchmark Plan prior to February 1, 2014 will transition to the Standard Plan on April 1, 2014 if they are still in their certification period.

A pregnant woman with income over 300% 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% 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) at the time of application can become eligible for BadgerCare Plus by meeting a deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan.. (See section 17.2)

There are no premiums for pregnant women. (See section 19.1)

All pregnant women, except those eligible under the BadgerCare Plus Prenatal Program, may have their eligibility backdated to the first of the month up to three months prior to the month of application.

This page last updated in Release Number: 14-01

Release Date: 02/0714

Effective Date: 02/01/14