18.1 Extensions

18.1.1 Introduction
18.1.2 Pregnant Women
18.1.3 Children

18.1.1 Introduction

A BadgerCare Plus extension is a period of eligibility given to a person when the assistance group's income increases above 100 percent 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 incomevisit your home and assess your health and your need for personal care services s below 100 percent 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 percent 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 percent 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 moving out of the State of Wisconsin at the time of the income increase, they would not be eligible for the Extension.

A family can enter into an Extension as long as verification and the premium payment, if applicable, are provided by the due date given.

In late renewal situations, the renewal must have been submitted in the month the renewal is due in order for this policy to apply.

Example 1: The Brown family’s health care renewal is due July 31. The renewal is submitted to the agency on July 25. The agency processes the renewal on July 28 and requests verification due August 7. The Brown family provides check stubs for the parents’ incomes on August 4. The agency determines that the Brown family’s income is now over 133 percent of the FPL, so the parents owe a premium. Because BadgerCare Plus already closed on July 31, a premium is due before the case can re-open. The Brown family has 10 days to pay the premium. The case pends for the premium on August 5, and the premium is due August 14. The Brown family must provide all requested verification by August 7 and pay their premium by August 14 in order for the family to enter into an 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 percent to 175 percent 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 percent FPL during the first 6 calendar months of their Extension. Starting April 1, 2014, the RRP for adults who fail to pay a premium will be 3 months (See 19.11). For RRPs that began 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, tested under MAGI rules, no longer qualify for Extensions when they have a natural or adoptive child in the household and that child meets the criteria for an Extension.

The BadgerCare Plus Extensions last four months when the income goes above 100 percent FPL solely due to 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.

Example 2: Mom, Dad, and children are open for MAGA and MAGC. Mom and Dad are not tribal members or disabled. They report a new job with income over 100 percent of the FPL. They fail to verify the income by the due date given. No one in the household is entitled to an Extension.

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 percent 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 percent FPL in 3 of the past 6 months she would be eligible for an Extension.

Example 3: 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 percent 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 percent 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 percent 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 4: Judith and her 2 children have been enrolled in BadgerCare Plus with income below 100 percent 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 percent FPL. Since she was enrolled with income at or below 100 percent 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 percent 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 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 percent 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 the Extension be continued 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 percent FPL and are under age 1
Have AG income under 191 percent FPL and are age 1 through age 5
Have AG income under 156 percent 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 percent 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 percent FPL the child’s extension continues. If the parent fails to verify income changes during the Extension period (but verifies it after the Extension has been established), the child’s Extension will continue.
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: 16-02

Release Date: 08/08/2016

Effective Date: 08/08/2016