State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

This page last updated in Release Number: 17-01 Release Date: 04/11/2017 Effective Date: 04/11/2017

19.1 BadgerCare Plus Premiums

The following must pay a premium to become or remain eligible for BadgerCare Plus unless exempt:

• Children in families with income over 201 percent of the FPLFederal Poverty Level

• Parents, stepparents, and caretaker relatives in a BadgerCare Plus extension with income over 100 percent of the FPL

 

Note: Parents, stepparents, and caretaker relatives in a BadgerCare Plus extension with income between 100 percent and 133 percent of the FPL will be subject to premiums starting in the seventh calendar month of their extension.

 

If a member’s income changes during his or her extension, he or she will only be exempt from premiums if he or she is in the first six calendar months of that extension, and if his or her income is at or below 133 percent of the FPL.  

 

• If the member has an increase in income that puts his or her income above 133 percent of the FPL, he or she will be subject to premiums, even if he or she is still in the first six calendar months of the extension.

• If the member’s income subsequently decreases to below 133 percent of the FPL, he or she will be exempt from premiums as long as he or she is in the first six months of the extension.

• If the member’s income drops below 100 percent of the FPL, he or she will be enrolled in regular BadgerCare Plus and is no longer subject to a premium.

• If the member’s income drops below 100 percent of the FPL, then later increases and the member qualifies for a new extension, a new six-month premium exemption will begin with the new extension.

• If the member’s income drops below 100 percent of the FPL, then later increases and the member does not qualify for a new extension, the member will be re-enrolled in the previous extension and the original six-month time frame for exempting premiums will apply.

 

Example 1: Jane starts a 12-month extension in June, when her income increases from 90 percent FPL to 110 percent FPL. If Jane’s income remains below 133 percent FPL, she will owe a premium beginning in December, the seventh month of her extension.

 

Example 2: Jane starts a 12-month extension in June, when her income increases from 90 percent FPL to 110 percent FPL. On August 5th, she reports she received a raise, and her income goes up to 155 percent FPL. Jane owes a premium starting in September. If her income stays above 133 percent FPL through November, she will continue to owe a premium, even though she is in the first six months of her extension. She will owe a premium, irrespective of whether her income is above or below 133 percent FPL, for December through May.

 

Example 3: Joe starts a 12-month extension in May, when his income increases from 90 percent FPL to 110 percent FPL. On June 3rd, he reports he received a raise, and his income goes up to 155 percent FPL. In July, he will owe a premium. In August, he reports a reduction in hours, bringing his income down to 120 percent FPL starting in the month of August. He will not owe a premium in August, September or October, but starting with the month of November, his six-month exemption is over, so he will start paying premiums again.

 

Example 4: Jim starts a 12-month extension in August, when his income increases from 90 percent FPL to 140 percent FPL. He owes a premium. He reports a reduction in hours effective December, which brings his income down to 120 percent FPL. He will not owe a premium in December or January, but starting in February, his six-month exemption is over, so he will start paying premiums again.

 

The following individuals are exempt from the requirement to pay a premium:

1. All pregnant women and pregnant minors,

2. Pregnant women under age 19 with income at or below 306 percent of the FPL,
3. Former Foster Care Youth (see Chapter 11 Foster Care Medicaid)
4. Children who have met a BadgerCare Plus deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan., during the remainder of the deductible period,
5. Children in a BadgerCare Plus extension,

6. Children who are not in an extension but whose parents are in an extension and paying a premium,

7. Adult parents and caretakers  who are blind or disabled or MAPP Disabled, as determined by the Disability Determination Bureau (DDB) or through the presumptive disability process (see Medicaid Eligibility Handbook, Section 5.9 Presumptive Disability),

8. Adults with assistance group income at or below 100 percent of the FPL,

9. All children under age 1 including Continuously Eligible Newborns (see Section  8.2 Continuously Eligible Newborns),
10. American Indian or Alaskan Native Tribal members, the son or daughter of a tribal member, the grandson or granddaughter of a tribal member, or anyone otherwise eligible to receive Indian Health Services.

 

Note: Persons who are members of families receiving BadgerCare Plus benefits, but who are individually certified for EBD Medicaid, Well Woman Care, Family Planning Only Services or Emergency Services, are not charged a BadgerCare Plus premium.

   

 

This page last updated in Release Number: 17-01

Release Date: 04/11/2017

Effective Date: 04/11/2017

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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