19.10 Premium Changes

19.10.1 Decreased Premium Amount
19.10.2 Increased Premium Amount

19.10.2.1 Person Adds
19.10.2.2 Effective Dates of Premium Increase (Person Add)
19.10.2.3 Effective Dates of Premium Increase (Other Than Person Adds)

19.10.1 Decreased Premium Amount

When a change is reported that results in a lower premium amount, it is effective during the month in which the change occurred or the month in which it was reported, whichever is later. The fiscal agent will refund any excess premium that was paid.

19.10.2 Increased Premium Amount

You must give a 10-day notice to the member when the group is required to pay a premium for the first time or is required to pay a higher premium. The increase is effective the following month if BadgerCare Plus eligibility is confirmed before adverse action . If the change is confirmed after adverse action, the increase is not effective until the month after the following month.

Example 1: Jessica has BadgerCare Plus with a premium for her and her family. She reports a change in income to her worker on April 23rd that results in a higher premium amount. Jessica’s premium amount will increase effective June 1st. She will receive the coupon for the new premium amount at the end of May.

19.10.2.1 Person Adds

If the person add will cause an increase in the premium, CARESThis system supports the Income Maintenance operations for DHS and DCF. CARES is used to determine eligibility, issue benefits, track premium payments, and manage support for BadgerCare Plus, EBD Medicaid, W-2, Child Care, and Work Programs. will not allow eligibility confirmation if the notice requirement cannot be met. Certify eligibility for new members through the ForwardHealth Portal. If unable to certify through the ForwardHealth Portal, complete and return the Medicaid/BadgerCare Plus Eligibility Certification form (F-10110) (formerly DES 3070) for the days that cannot be confirmed in CARES (see Process Help Chapter 81). The form can be returned in the following ways:

By mail:

ForwardHealth iChange

P.O. Box 7636

Madison, WI 53707-7636

By fax: 608-221-8815

19.10.2.2 Effective Dates of Premium Increase (Person Add)

If the person was added to the case before adverse action, the increase is effective the next month.
If the person was added to the case after adverse action, the increase is not effective until the second month.

Example 2: Rachel’s husband Mike moved back into the home on June 1. She reported the change on June 6 and the agency processed the change on June 10 (before adverse action). Inclusion of Mike’s income resulted in a premium increase. The increase is effective July 1. Certify Mike’s BadgerCare Plus eligibility effective June 6th by sending in a F-10110 for the dates between June 6th and June 30.

Example 3: Ann moved back to her parent’s home on December 12 and reported it on December 22 (after adverse action). The agency acted to process the change on the same day. Inclusion of Ann’s income resulted in a premium increase. The premium increase is not effective until February 1. Certify Ann’s BadgerCare Plus eligibility effective December 22 by submitting an F-10110 for the dates between December 22 and January 31.

19.10.2.3 Effective Dates of Premium Increase (Other Than Person Adds)

A delay in the effective date of premium increases must also be done in certain ongoing cases that may or may not include a person add. These are cases where a change results in an assistance group opening up and has new or increased premiums for a month (or months) that cannot be confirmed in CARES. In these situations, the member is not responsible for a premium payment (or a premium increase) for the month or months that cannot be confirmed in CARES. The first premium (or increased premium) for which the family must pay is the one for the month for which eligibility can be confirmed.

The following situations qualify for this treatment:

A person is added to a case that has not paid the premium for another member.
A person becomes eligible for BadgerCare Plus for any non-financial reason except late payment of the previous month’s premium, failure to verify a reported change that resulted in the premium increase, or failure to complete a renewal.
Cases where the Call Center is unable to get premiums adjusted on the interChange system.
A case reports a decrease in income from above 306% to below 306% and the child(ren) are now eligible with a premium.

Example 4: Mary and Tom apply for BadgerCare Plus on May 1 for their son, Sam, and Mary’s daughter, Sara. Mary and Tom are not married and both plan to file taxes. Mary claims Sara as a dependent and Tom claims Sam. Sara’s AG income is 208%, so she has a $10 premium. Sam’s AG income is at 310%, so he is not eligible for BadgerCare Plus. The case is confirmed on May 15 with Sara’s eligibility beginning May 1. On June 1, Tom reports his income decreased in late March, resulting in Sam’s AG income to decrease to 265%. Sam would now be eligible with a $44 premium. Because CWW will not allow the worker to confirm the increase in premium for June, Sam will not be required to pay a premium until July 1, although he will be eligible as of June 1. Sara is still required to pay her $10 June premium, and the combined premium of $54 will be effective July 1.

This page last updated in Release Number: 17-01

Release Date: 04/11/2017

Effective Date: 04/11/2017