16.1 Income

16.1.1 Income Limits
16.1.2 Income Under Non-MAGI Rules
16.1.3 Income Under MAGI Rules
16.1.4 Gap Filling

16.1.4.1 Processing Application for Individuals Eligible Under Gap Filling Rules
16.1.4.2 Processing Renewals for Individuals Eligible Under Gap Filling Rules
16.1.4.3 Eligible Under Another Category of BadgerCare Plus or Medicaid

16.1.1 Income Limits

Population	Income Limit for Existing members through March 31, 2014	Income Limit for New Applications as of February 1, 2014	Income Limits for all Members effective April 1, 2014
Pregnant Women	300% 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. rules)	306% FPL (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)	300% 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. rules) 306% FPL (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 under 19*	No Limit	No Limit	300% 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. rules) 306% FPL (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)
Parents/Caretaker Relatives	200% FPL	100% FPL	100% FPL
Childless Adults	200% FPL	N/A	100% FPL
Family Planning Only Services	300% 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. rules)	306% FPL (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)	300% 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. rules) 306% FPL (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 and pregnant women with income above the limit can become eligible by meeting a deductible.

See Chapter 50.1 for the most recent Federal Poverty Level limits.

The income limits under MAGI rules listed above include the following income disregards.

Children, pregnant women and individuals eligible under Family Planning Only Services will be allowed an income disregard equal to 5% of the FPL in addition to a conversion factor adjustment equal to 1% of the FPL. While the income limit remains 300% FPL, CWW will actually test against an income limit of 306% FPL once the income disregard and conversion factor are included.
Parents, caretakers and childless adults already have the income disregard included in the income limit of 100% FPL. CWW will test against an income limit of 100% FPL.

Note: Other effective income limits for children 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 reflect the addition of the 6% disregard with the exception that the income thresholds for children’s premiums will only be increased by 1%.

16.1.2 Income Under Non-MAGI Rules

In general, all available gross income is counted when determining BadgerCare Plus eligibility under non-MAGI rules for existing BadgerCare Plus members with a filing date prior to February 1, 2014. See unavailable income below for exceptions to this rule.

Gross income is the total income before any amounts are subtracted or withheld (i.e. taxes, garnishments, repayment amounts, etc.)

Net income is the amount of income after deductions are withheld.

Available income . Income is available when:

It is actually available, and
The person has a legal interest in it, and
The person has the legal ability to make it available for support and maintenance.

An example of an income source that someone can make available is unemployment compensation.

When it is known that a member of the group is eligible for income or an increased amount of income:

If the amount is known, count the income as if the person is receiving it.
If the amount is unknown, ignore the income.

Example 1: Ms. M. is entitled to Worker’s compensation benefits of $430. However, she declined a $100 increase offered by the insurance company, and the amount of her check remains at $430. Since the full entitlement amount is known, the available income is $530.

Unavailable Income: Income is unavailable when it will not be available for 31 days or more. The person must document that it will not be available for 31 days or more.

Unavailability is documented by a letter from the source of the income stating when the person will receive the benefit. Thus, if he or she has just applied for benefits, the income would not be counted. The income is not ignored; it is just not counted until it becomes available. Schedule an eligibility review for no later than the 60th day.

All taxable income is counted when determining BadgerCare Plus eligibility 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. Social Security income is also counted under MAGI rules. See 16.2 for the list of income that is not counted. These rules apply to families that are filing taxes and those who are not.

16.1.3 Income Under MAGI Rules

All taxable income is counted when determining BadgerCare Plus eligibility under MAGI rules. Social Security income is also counted under MAGI rules. See 16.2 for the list of income that is not counted. These rules apply to families that are filing taxes and those who are not.

Within a MAGI group, income will be counted as detailed in Chapter 2. For any member whose income is budgeted for their assistance group, income under the countable income types listed in 16.4 and 16.5 will be counted and deductions under the types listed in 16.3 will be allowed. See Chapter 2 for determining the assistance group size.

All MAGI group members’ income is counted with one exception: If a group member is the child or tax dependent of another group member, his or her income is only counted if he or she is “expected to be required” to file a tax return for the current year. See section 2.8.2 for more information.

If a member’s income is budgeted for his or her assistance group, his or her deductions will be counted for that group. In situations where an individual is planning to file a joint tax return with his or her spouse, the individual’s deductions may offset the spouse’s income even if the individual has no income.

Note: The availability of income does not affect whether or not the income is counted under MAGI rules.

When it is known that a member of the group is eligible for income or an increased amount of income:

If the amount is known, count the income as if the person is receiving it.
If the amount is unknown, ignore the income.

Example 2: Ms. M. is entitled to Unemployment compensation benefits of $430. However, she declined a $100 increase offered by unemployment compensation, and the amount of her check remains at $430. Since the full entitlement amount is known, the available income is $530.

16.1.4 Gap Filling

Due to differences between the eligibility rules used by the Marketplace for Advanced Premium Tax Credits (APTC) and the eligibility rules used when counting income for BadgerCare Plus, the Marketplace may find someone to be below 100% FPL based on their annual income, while BadgerCare Plus may find someone to be above 100% FPL based on their current monthly income. Because of this difference in eligibility rules, the individual is eligible for neither BadgerCare Plus nor APTCs. If applicants were left in this eligibility “gap”, then only option available is to pay for the full cost of private health insurance through the Marketplace. To prevent this from happening, we must enroll these individuals based on a monthly equivalent of their expected annual income under a process called “gap filling”.

16.1.4.1 Processing Application for Individuals Eligible Under Gap Filling Rules

Local agencies should contact the DHS CARES Call Center when an individual has applied at the Marketplace and has received a notice indicating that they can purchase health insurance but cannot get an APTC, and has also been denied BadgerCare Plus because of monthly income above 100% FPL.

The CARES Call Center will confirm whether the individual meets the criteria for gap filling certification. If so, the CARES Call Center will add a case comment to CWW. EM CAPO will then manually certify the member, track his or her individual enrollment outside of CWW, and serve as the point of contact for that member’s eligibility under gap filling rules. The EM CAPO will send a notice of decision informing the individual of his or her eligibility and change reporting rules. Changes for that individual will be reported to and processed by the EM CAPO while he or she is eligible under gap filling rules.

The case itself will remain with the consortium, which will manage eligibility for other programs or individuals who may be open as part of that case.

16.1.4.2 Processing Renewals for Individuals Eligible Under Gap Filling Rules

Because the Marketplace considers annual income on a calendar-year basis, the manual gap-filling certification will last until the end of the calendar year. Approximately 45 days prior to the end of the year, members will receive a notice from EM CAPO advising them that their eligibility is ending and directing them to return to the Marketplace (or, if appropriate, reapply for BadgerCare Plus). A gap-filling member can also lose eligibility during the certification period if:

He or she moves out of state; or,
He or she has expected annual income of more than 100% FPL.

16.1.4.3 Eligible Under Another Category of BadgerCare Plus or Medicaid

EM CAPO will end the gap-filling certification if the member has become eligible in another category of BadgerCare Plus or Medicaid.

This page last updated in Release Number: 15-01

Release Date: 05/15/2015

Effective Date: 05/15/2015