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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
BadgerCare Plus is a state/federal program that provides health coverage for Wisconsin families and individuals living in poverty. BadgerCare Plus replaced the former AFDC-Medicaid, Healthy Start, and BadgerCare programs.
Potential BadgerCare Plus members will include:
Children under 19 years of age,
Pregnant women,
Parents and caretakers of children under 18 and dependent 18 year olds,
Parents and caretaker relatives whose children have been removed from the home and placed in out of home care,
Former foster care youth under age 26 who were in out-of-home care when they turned 18, and
Effective April 1, 2014, adults ages 19-64 who are not receiving Medicare and do not have dependent children.
For information on income limits, see Section 16.1 Income and Section 50.1 Federal Poverty Level Table. A person is eligible for BadgerCare Plus if he or she meets all BadgerCare Plus non-financial and financial requirements.
Documented and undocumented immigrants who are children, parents, or caretakers and who are ineligible for BadgerCare Plus solely due to their immigration status may be eligible for coverage for BadgerCare Plus Emergency Services.
Documented and undocumented immigrants who are pregnant and ineligible for BadgerCare Plus solely due to their immigration status may be eligible for the BadgerCare Plus Prenatal Program.
Women and men 15 years of age or older may be eligible for limited benefits undeer the BadgerCare Plus Family Planning Only Services program.
Women ages 35-65 diagnosed with cervical or breast cancer may be eligible for Well Woman Medicaid. See the Medicaid Eligibility Handbook for more information on Well Woman Medicaid.
Individuals who are elderly, blind or disabled may be eligible for Medicaid. Medicaid is a state/federal program that provides health coverage for Wisconsin residents that are EBD . Medicaid is also known as Medical Assistance, MA, and Title 19. There are different subprograms of Medicaid:
See the Medicaid Handbook for more information about these subprograms.
This handbook outlines eligibility policy for Wisconsin’s BadgerCare Plus program. This version documents multiple policy changes that will affect the BadgerCare Plus program in 2014 as a result of changes in state law and the federal Affordable Care Act. Accordingly, this handbook contains policy for the BadgerCare Plus program that is currently in effect and policy that will take effect in 2014. Policy that is time-limited or time-dependent will be modified with the appropriate effective date. Policy that is not identified as having an effective or end date is currently in place and will continue to exist in 2014.
Beginning in 2014, the BadgerCare Plus program will use a different set of eligibility rules to determine household size and countable income. This version of the handbook addresses two forms of budgeting rules. More information about these budgeting methodologies is found in Chapter 2 BadgerCare Plus Group. The new budgeting rules that will be applied to applicants and members in 2014 will be referred to as MAGI rules. The rules currently in place for BadgerCare Plus will be referred to as non-MAGI rules.
The Standard Plan is for adults, parents, or caretakers with household income at or below 100 percent of the FPL and children and pregnant women with income at or below 300 percent of the FPL (see Section 50.1 Federal Poverty Level Table for FPL limits).
BadgerCare Plus has several limited health plans. These include:
Family Planning Only Services
BadgerCare Plus Prenatal Program, and
BadgerCare Plus Emergency Services
Standard plan members may be asked to pay a share of the cost of services. The copayment amount ranges from $.50-$3.00 per service.
Beginning February 1, 2014, all new applicants found eligible for BadgerCare Plus will be covered under the Standard Plan. Beginning April 1, 2014, all BadgerCare Plus members, regardless of when they applied, will receive coverage under the Standard Plan.
It is possible for individuals to qualify for both BadgerCare Plus and EBD Medicaid based on financial and non-financial eligibility criteria.
When a person is eligible for both BadgerCare Plus and EBD Medicaid, different rules apply based on whether the BadgerCare Plus eligibility is determined under non-MAGI or MAGI rules.
When eligibility is determined for such an individual under non-MAGI rules, CARES will automatically enroll the individual in the program with the best benefit plan and lowest cost share. The individual has the right to request coverage under the program not chosen by CARES (see Section 49.1 Health Plan Choice). The change will be effective in the next possible payment following Adverse Action , unless the member requests the change be effective in the month the request to change the health plan was made.
If CARES is unable to make an automatic choice between BadgerCare Plus and EBD Medicaid, a notice requesting the individual make a choice will be generated. Once the member has made a choice, the decision remains in effect until:
The member requests a change, or
The member’s benefit under the health plan of his or her choice ends. (This includes being placed into an unmet deductible AG .)
When eligibility is determined for such an individual under MAGI rules, federal law requires that once an individual has been determined eligible for EBD Medicaid, he or she must be enrolled in EBD Medicaid, even if they are also eligible for BadgerCare Plus, unless they have a change in circumstances that results in ineligibility for EBD Medicaid. The only exception to this policy is pregnant women who are eligible for both EBD Medicaid and BadgerCare Plus. In these instances, the pregnant woman will be enrolled in the BadgerCare Plus program.
If someone is pending for EBD Medicaid or if they have an unmet deductible for EBD Medicaid, the individual is not considered eligible for EBD Medicaid and can enroll in BadgerCare Plus. Pending for EBD Medicaid includes, but is not limited to, waiting for an official disability determination from DDB. If an individual enrolled in EBD Medicaid is determined ineligible for EBD Medicaid for any reason, including going over the asset limit or failing to pay a MAPP premium, he or she can enroll in BadgerCare Plus if he or she is still eligible to do so.
The following application options are available for anyone who is applying for BadgerCare Plus:
ACCESS online application at https://access.wisconsin.gov/
Face-to-face interview at the local county/tribal office
Paper application
Telephone interview
An application submitted to the Federally Facilitated Marketplace .
Click here to view the directory of local county/tribal agencies in Wisconsin or call 1-800-362-3002.
This page last updated in Release Number: 14-02
Release Date: 05/14/14
Effective Date: 04/01/14
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