18.1 BadgerCare Plus Extensions

18.1.1 BadgerCare Plus Extensions Introduction

A BadgerCare Plus Extension is a period of eligibility given to a person when the assistance group's income increases above 100% FPL either due to an increase in earned income, child support income, and/or spousal support; and otherwise meets the BadgerCare Plus eligibility criteria for persons with incomes below 100% FPL.

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. BadgerCare Plus individuals (parents/caretakers, pregnant women, and children) can enter an extension when the assistance group’s earned income, child support, or both increases above 100% FPL.
A parent/caretaker relative or pregnant woman whose eligibility is determined using 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 can enter an Extension due to an increase above 100% FPL in the assistance group’s earned income, spousal support, or both. The children, stepchildren, and NLRR children of the parent/caretaker will also enter the Extension at this time, provided they are under age 19, living with the parent/caretakers, and meet the income requirements outlined in section 18.1.3.

BadgerCare Plus members eligible as childless adults are not eligible for an Extension. If a family is also moving out of the State of Wisconsin at the time of the income increase, or if a case closes for lack of review or verification and then later reapplies, they would not be eligible for the Extension. While on the Extension, the member is covered under the Standard Plan and is not subject to the insurance access and coverage requirements. For example, having access to employer health insurance when the family income increases from 80% to 175% FPL will not make them ineligible for the Extension. Non-exempt adults are subject to premiums while in an Extension (see 19.1) with the exception of adults whose income is at or below 133% FPL during the first 6 calendar months of their Extension. Starting April 1, 2014, the restrictive re-enrollment period for adults who fail to pay a premium will be 3 months (See 19.11). For RRPs that being prior to April 1, 2014, if the adult member has served at least 3 months in an RRP, the RRP may be ended. Former Foster Care Youth 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 are eligible for a BadgerCare Plus Extension when they have a natural or adoptive child in the household and that child meets the criteria for an Extension. If the FFCY is tested 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 FFCY will no longer qualify for Extensions.

The BadgerCare Plus Extension lasts 4 months when the income goes above 100% FPL solely due to an increase in child support or spousal support. Child support Extensions can occur for anyone under non-MAGI rules. Because child support is not a counted income type under MAGI rules, such Extensions for members tested under MAGI rules can only occur based on an increase in spousal support.

Note: Extensions will not be granted to anyone in the household if the household fails to verify the income that would trigger the extension unless all the parents/caretakers in the Extension are exempt from paying premiums because they are disabled, a tribal member or pregnant.

18.1.2 Pregnant Women

A pregnant woman tested 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 who is not a parent or caretaker relative of a child during her pregnancy, can only become eligible for an Extension if she was enrolled in BadgerCare Plus, with income at or below 100% of the FPL, for 3 months once her pregnancy reaches the 8th month. Look back 60 days from her due date or the date the pregnancy ended to determine the 8th month. If she was a parent or caretaker relative and enrolled with income at or below 100% FPL in 3 of the past 6 months she would be eligible for an Extension.

Example 1: June, a single woman with no children under her care, was pregnant with a due date of September 8th. She applied for and was enrolled in BadgerCare Plus effective March 1st. Her income was below 100% of the FPL for the entire time she was enrolled. She gave birth on September 8th and reported the birth and her marriage to the father of the baby to her worker. His income put the countable household income over 100% of the FPL. Since the eighth month of her pregnancy was July (September 8th minus 60 days), she was enrolled in BadgerCare Plus with income less than 100% for three months (July, August and September), beginning with the 8th month of her pregnancy. She is eligible for a 12 month BadgerCare Plus Extension.

Example 2: Judith and her 2 children have been enrolled in BadgerCare Plus with income below 100% FPL since January. In March, she reported that she was pregnant with a due date of October 5th. On August 10th, Judith reported she received a raise which caused her countable household income to exceed 100% FPL. Since she was enrolled with income at or below 100% FPL for 3 out of the past 6 months, she and her children are eligible for an Extension. Since Judith is eligible as a pregnant woman, she will retain that status in the Standard Plan with no premium until the end of the month 60 days after the pregnancy ends. At that time she will be put into the Extension with her children.

Beginning January 1, 2014, a pregnant woman whose eligibility is tested under MAGI rules will be able to enter an Extension if she was eligible for BadgerCare Plus as a pregnant woman or a parent or caretaker relative at any time during the pregnancy with income at or below 100% FPL in 3 of the past 6 months. In most cases, her continuous eligibility as a pregnant woman will take precedence over the Extension, but the Extension will be maintained and will result in eligibility if the pregnancy and postpartum period end prior to the end of the Extension.

18.1.3 Children

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, Extensions apply to all the parents and children in the home who are eligible as part of the same BadgerCare Plus Test Group (2.3.1). When the Test Group’s income exceeds 100% FPL due to increased earnings or child support, all members of the affected BadgerCare Plus group go into the Extension, as long as at least one member of the group was eligible with income below 100% FPL for 3 of the previous 6 months. Likewise, under most circumstances, the end of an Extension will apply to all of the members of the BadgerCare Plus Test group. For example, when the household income decreases to 100% FPL or less, the Extension will end for both parents and children. Only when an Extension ends for a parent for failure to pay a required premium will we continue the Extension for the child.

All dependent children, stepchildren and NLRRNon-legally Responsible Relative (NLRR) Caretaker is a caretaker who has no legal responsibility for the child under their care. NLRR caretakers and their spouses can be eligible for BC+ as caretakers. children who are eligible under MAGI rules and whose parent or caretaker becomes eligible for an Extension under MAGI rules will be eligible for the same Extension provided that they are eligible for BadgerCare Plus in the month prior to the start of the Extension and:

Have AG income under 306% FPL and are under age 1
Have AG income under 191% FPL and are age 1 through age 5
Have AG income under 156% FPL and are age 6 through age 18

Conditions:

Children do not have to be eligible for BadgerCare Plus for 3 of the past 6 months.
The child’s AG income does not have to be below 100% FPL at the time the Extension starts.
CENs are not eligible for Extensions.
A child who is currently in an Extension is not eligible for a new extension.
If a parent’s income decreases below 100% FPL the child’s extension continues.
Once a child is in an Extension, the child does not lose the extension for any reason except for death, moving out of Wisconsin, or turning 19 while in an earned income Extension.

Note: If a child is in an unexpired Extension and a parent qualifies for a new Extension, the child’s Extension will continue to stay in the original Extension eligibility category until it expires. The child is not eligible for the new Extension.

This page last updated in Release Number: 14-02

Release Date: 05/14/14

Effective Date: 04/01/14