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 and/or spousal support and otherwise meets the BadgerCare Plus eligibility criteria for people with incomes below 100 percent FPL.

A parent/caretaker relative or pregnant woman 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 Children.

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 or verification is provided prior to BadgerCare Plus closing.

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.

Example 2: The Brown family’s health care renewal is due July 31. The renewal is submitted on August 9. They are not eligible for an extension.

Example 3: The Green family reports a change in income, and verification is due on August 8. The Green family does not provide verification by August 8, and the agency closes BadgerCare Plus for August 31. The verification is turned in August 17. Because BadgerCare Plus is still open (BadgerCare Plus does not close until August 31), they have provided verification timely and are eligible for an extension. If the verification was turned in on or after September 1, then they would not be eligible for an extension.

Example 4: The White family has a renewal due July 31. The renewal is submitted on July 25. The agency requests income verification that is due on August 5. The income verification is received, and it is determined a premium is owed and due on August 17. If the White family pays the premium by August 17, the extension can begin August 1. If the premium is paid after August 17, the premium should be returned and no extension granted.

While on the extension, children are 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. Adults are subject to premiums while in an extension, unless exempt (see Section 19.1 BadgerCare Plus Premiums). Premiums are not charged to adults whose income is at or below 133 percent of the FPL during the first six calendar months of their extension. The RRPRestrictive Re-enrollment Period. The period of time an individual is not eligible to enroll in BadgerCare Plus due to non-payment of a premium. for adults who fail to pay a premium is three months (see Section 19.11 BadgerCare Plus Restrictive Re-enrollment Period).

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 5: 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 is 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 ot the FPL in three of the past six 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. However, when the household income decreases to 100 percent FPL or less, the extension will end for the parent(s), but any children would remain in the extension. When an extension ends for a parent for failure to pay a required premium, the extension continues 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 whose parent or caretaker becomes eligible for an extension 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: 17-01

Release Date: 04/11/2017

Effective Date: 04/11/2017