8.2 Continuously Eligible Newborns

Newborn children are automatically eligible for BadgerCare Plus from the date of birth through the end of the month in which they turn 1 year old if both the following are true:

They are younger than 13 months old.
The natural mother was determined eligible in the state of Wisconsin for one of the following programs:
1. BadgerCare Plus
2. Other full-benefit Medicaid (see Medicaid Eligibility Handbook Section 21.2 Full-Benefit Medicaid)
3. Emergency Services BadgerCare Plus
4. Emergency Services Medicaid (see Medicaid Eligibility Handbook Section 34.1 Emergency Services)
5. BadgerCare Plus Prenatal Program (as a nonqualifying immigrant)

There is no income or resource test for these children while they are eligible under this status; therefore, they are not required to provide any income tax filing information in order for their BadgerCare Plus eligibility to be determined.

Note: Children born to incarcerated mothers will not be eligible as CENContinuously eligible newborns. In addition, children born to pregnant minors with family income over 300 percent FPL who were eligible for BadgerCare Plus are not eligible as CENs. This policy only applies through March 31, 2014, because children will no longer be eligible above 300 percent FPL as of April 1, 2014. The natural mother’s eligibility could have been determined either prior to the date of delivery or retroactively to cover the date of delivery.

Example: Sasha gave birth on April 15. On June 15, she applied for BadgerCare Plus. Her eligibility was backdated to March 15. Her infant son is eligible as a CEN from April 15 through April 30 of the following year, the end of the month in which he turns 1 year old.

The newborn child does not receive this automatic eligibility as a CEN if the mother's BadgerCare Plus enrollment is a temporary enrollment through the Express Enrollment program.

A newborn is not required to reside with his or her mother to be eligible as a CEN. This is true even if the newborn is being placed in foster care, adoption, or is residing with a caretaker relative . A CEN who no longer resides with his or her mother but still resides in Wisconsin should remain eligible as a CEN through the end of the month in which he or she turns 1 year old.

Through March 31, 2014, the child will be covered under either the Standard or the Benchmark Plan, depending on the plan the mother was covered by at the time of the baby’s birth. Effective April 1, 2014, all infants eligible for BadgerCare Plus as a CEN will be covered under the Standard Plan. If the child is enrolled in BadgerCare Plus on or after February 1, 2014, the child will be covered under the Standard Plan upon enrollment. If the child is covered by the Benchmark plan prior to February 1, 2014, the child will transition to the Standard plan effective April 1, 2014. Anyone who has ever been eligible as a CEN under Wisconsin Medicaid or BadgerCare Plus is exempt from the citizenship and identity documentation requirements.

The CEN will not have to pay premiums and is not subject to the health insurance access/coverage requirements.

This page last updated in Release Number: 15-02

Release Date: 09/02/2015

Effective Date: 09/02/2015