17.1 Deductibles

Children (younger than 19 years old) with income over 306 percent of the FPLFederal Poverty Level may become eligible for BadgerCare Plus by meeting a deductible. Children with income over 156 percent of the FPL who are denied BadgerCare Plus solely due to access to health insurance may also become eligible for BadgerCare Plus by meeting a deductible. The deductible amount is calculated for a six-month period using the amount of income that exceeds 156 percent of the FPL.

Pregnant women with incomes above 306 percent of the FPL can qualify for BadgerCare Plus by meeting a deductible. The deductible amount is calculated for a six-month period using the amount of income that exceeds 300 percent of the FPL for pregnant women. The deductible is met by incurring medical expenses that equal the deductible amount. Pregnant women who could only qualify for the BadgerCare Plus Prenatal Program may not become eligible for the Prenatal Program by meeting a deductible.

Note: When determining the deductible amount, only the income of the applicant, the applicant's spouse, and, if the applicant is younger than 19 years old, the applicant’s parents, should be considered. If a sibling or other tax dependent has been counted as part of the applicant’s regular MAGI assistance group, the sibling's or tax dependent's income should be excluded for purposes of calculating the deductible; however, he or she should still be included in the assistance group size.

This page last updated in Release Number: 17-01

Release Date: 04/11/2017

Effective Date: 04/11/2017

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