39.1 Emergency Services Income Limits

BadgerCare Plus Emergency Services is a limited BadgerCare Plus benefit for documented immigrants who have not been in the U.S. for 5 years or more and for undocumented immigrants.

A citizen is not eligible for BadgerCare Plus Emergency Services even when he or she cannot produce citizenship and/or identity verification.

Example 1: Jill applies for BadgerCare Plus, declares U.S. citizenship and is asked to provide documents proving her citizenship and identity. She has a driver license to prove identity but does not have anything to prove her citizenship. Since Emergency Services BadgerCare Plus does not require proof of citizenship and identity as an eligibility requirement, she then asks to be considered for this program. However, the IM worker cannot process BadgerCare Plus Emergency Services eligibility for persons declaring to be U.S. citizens. BadgerCare Plus Emergency Services is reserved for non-qualifying non-citizens.

Because Emergency Services is funded through Title XIX only those who would receive their BadgerCare Plus benefits under Title XIX are eligible for BadgerCare Plus Emergency Services. Therefore, not everyone who meets the income limits for BadgerCare Plus qualifies for BadgerCare Plus Emergency Services.

Prior to April 2014, an immigrant who only met the eligibility criteria for the BadgerCare Plus Core Plan was not eligible for Emergency Services. Starting April 2014, immigrants who only meet the criteria for BadgerCare Plus under the childless adults’ coverage group 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 will also be ineligible for Emergency Services. An immigrant who is ineligible for BadgerCare Plus because of his or her immigration status is eligible for BadgerCare Plus Emergency Services coverage if:

He or she meets the income limits listed in the chart below and
Meets all other eligibility requirements, except having or applying for an SSNSocial Security number .

BadgerCare Plus Emergency Services Income Limit Through January 31, 2014

Group	Income
Pregnant Women	Up to 300% FPL
Newborns to age 1	Up to 300% FPL
Children ages 1 - 5	Up to 185% FPL
Children ages 6 - 18	Up to 150% FPL
Former Foster Care Youth	Any FPL Level
Parents and Caretakers	Up to 200% FPL

BadgerCare Plus Emergency Services Income Limit Effective February 1, 2014

A 5% income disregard and 1% conversion factor will be applied to the Emergency Services income limit for pregnant women and children effective January 1, 2014.

Group	Income
Pregnant Women	Up to 306% FPL
Newborns to age 1	Up to 306% FPL
Children ages 1 - 5	Up to 191% FPL
Children ages 6 - 18	Up to 156% FPL
Former Foster Care Youth	Any FPL Level
Parents and Caretakers	Up to 100% FPL

Note: Pregnant non-qualifying immigrants may be eligible under the BadgerCare Plus Prenatal Program.

An emergency means a medical condition (including labor and delivery) that shows acute symptoms of sufficient severity (including severe pain) such that the lack of immediate medical treatment could result in one or more of the following:

Serious jeopardy to the patient's health.
Serious impairment to bodily functions.
Serious dysfunction of a bodily organ or part.

BadgerCare Plus Emergency Services covers :

Only those medical services needed for the treatment of an emergency medical condition.
All labor and delivery services for eligible non-qualifying immigrants.

See Process Help Chapter 11.1, for BadgerCare Plus Emergency Services manual 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. processing.

This page last updated in Release Number: 14-03

Release Date: 09/02/14

Effective Date: 04/01/14