State of Wisconsin Department of Health Services

HISTORY

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

25.8 Begin Dates

25.8.1 Backdated Eligibility

25.8.1.1 BadgerCare Plus Family Planning Only Services

25.8.1.2 Pregnant Women

  BadgerCare Plus eligibility begins the first day of the month in which the valid 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. is submitted and all eligibility requirements are met, with the following exceptions.  Those begin dates are the date a valid application is submitted, all eligibility requirements are met, and:

1. DeductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan. - The date the deductible was met.
2. Inmates - The date the member is no longer an inmate of a public institution. See Section 3.6 for more information on exceptions.
3. Newborn - The date the child was born.   
4. Person Adds - The date the person moved into the household.
5. BadgerCare Plus Prenatal Program - The first of the month in which a completed application is received and the pregnancy is verified.

Note: As of January 1, 2014, pregnancy for the BadgerCare Plus Prenatal Program will only be verified if the worker has information that contradicts the individual’s self-declaration.

1. Recent Moves - The date the member moved to Wisconsin.
2. Insurance Coverage ends with good cause - The begin date for BadgerCare Plus is the date following the coverage end date.

25.8.1 Backdated Eligibility

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 calendar months prior to the month of application.   All former foster care youth that meet the criteria in Chapter 11 may have their eligibility backdated to the first of the month, up to three calendar months prior to the month of application.   All disabled adults may have their eligibility backdated to the first of the month, up to three calendar months prior to the month of application.  

Children determined eligible for BadgerCare Plus are eligible for the following periods of backdated eligibility:

• Infants less than 1 year old may have their eligibility backdated up to the first of the month, three calendar months prior to the month of application for any of the months in which their family income was at or below 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 at or below 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),

• Children ages 1 through 5 may have their eligibility backdated up to the first of the month, three calendar months prior to the month of application for any of the months in which their family income was at or below 185% 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 at or below 191% 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), and

• Children ages 6 through 18 may have their eligibility backdated up to the first of the month, three calendar months prior to the month of application for any of the months in which their family income was at or below 150% FPL prior to December 31, 2013 (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 at or below 156% 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).

 

All non-pregnant, non-disabled parents and caretakers may have their eligibility backdated up to the first of the month, three calendar months prior to the month of application for any of the months in which their family income was:

• At or below 133% FPL, for new applications submitted prior to February 1, 2014

OR

• At or below 100% FPL, for new applications submitted after February 1, 2014.

  Childless adults with assistance group income under 100% FPL will be eligible for backdating beginning in 2014. However, retroactive coverage cannot begin prior to April 1, 2014. As a result, a childless adult could not be eligible for the full three calendar months period of backdating until July 1, 2014.   If certifying for retroactive BadgerCare Plus, do not go back further than the first of the month, three months prior to the application month.  Certify the person for any backdate month in which he or she would have been eligible had he or she applied in that month.  In the case of children, certify the person for any backdate month in which he or she would have been eligible had he or she applied in that month and in which their assistance group income was at or below the appropriate FPL level for their age group.   A backdate request can be made at any time, except in the case where the member is already enrolled and backdating the member’s eligibility would result in a deductible for the backdated period.   If a member has incurred a bill from a BadgerCare Plus certified provider during a backdate period, instruct the member to contact the provider to inform them to bill BadgerCare Plus.  The member may be eligible to receive a refund, up to the amount already paid to the provider.

 

 

Example 1:  Mary who is pregnant with an August due date, applied for BadgerCare Plus on April 6th, and was found eligible.  At the time of application, Mary did not request a backdate.     In September Mary is billed for a doctor’s appointment she had at the end of February.  Mary can ask to have her eligibility backdated through February.  She meets all non-financial and financial eligibility criteria in the months of February and March.  Her worker certifies her for BadgerCare Plus for both months.

 

 

 

Example 2:  Jess applied for BadgerCare Plus on May 2, 2014 and was found eligible as a childless adult, with coverage beginning May 1, 2014. At the time of application, Jess requested three months of backdated coverage, through February 1, 2014. Because Jess is eligible as a childless adult and coverage cannot be backdated for childless adults prior to April 1, 2014, Jess will only receive backdated coverage in April 2014.

25.8.1.1 BadgerCare Plus Family Planning Services  

Eligibility for FPOSFamily Planning Only Services - This plan provides certain services and supplies to people who are of childbearing or reproductive age to prevent unplanned pregnancies. begins on the first of the month of application, if all non-financial (40.4) and financial (40.5) eligibility requirements are met.  FPOS may be backdated up to three months from the month of application.

25.8.1.2 Pregnant Women

 

 

Except those women eligible only under the BadgerCare Plus Prenatal Program, backdate a pregnant woman to whichever is more recent:

 

 

1. The first of the month in which the pregnancy began.

 

 

2. The first of the month, three months prior to the month of application.  If a woman was pregnant before the date of her application, backdate her BadgerCare Plus even though she is not pregnant on the date of application.  Do not, however, continue her eligibility as a pregnant woman beyond the end of the pregnancy.  Before backdating her BadgerCare Plus, verify that she has met all the eligibility requirements during the backdated period.

  See (41.5) for the BadgerCare Plus Prenatal eligibility begin date policy.        

 

This page last updated in Release Number: 14-02

Release Date: 05/14/14

Effective Date: 04/01/14

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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