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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
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This page last updated in Release Number: 17-01 |
Children with assistance group income above 201% of the FPL will be required to pay premiums. The total premium amount for the household is the total of the individually calculated premiums, not to exceed a 5% cap. The cap will be 5% of the income of the assistance group with the highest income (in terms of dollar amount) in the case.)
The 5% cap methodology for children with premiums will be effective as soon as one child on the case who is subject to premiums has his or her eligibility determined using MAGI rules.
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Example: Susan and Alan are non-marital co-parents caring for four children: Susan’s son, Aaron (15); Alan’s daughters Rachel (12) and Hannah (11); and Susan and Alan’s son Jacob (9). Alan claims Rachel and Hannah as his two tax dependents, while Susan claims Aaron and Jacob. Susan earns $2,500/month as a waitress, and Alan earns $4500/month as a computer analyst. None of the children have income. All four children are eligible for BadgerCare Plus.
Aaron does not have a premium, Rachel and Hannah have $44 premiums, and Jacob has a premium of $34. In this example, 5% of the income of the assistance group with the highest income is 5% of Jacob’s MAGI group, or 5% of $7000/month, or $350. Altogether, the household’s monthly premiums are $122. The household will pay $122 in premiums for their children’s coverage. |
Parents and caretakers in extensions will pay premiums based on the sliding scale discussed above, without a 5% cap applied. Non-exempt children with incomes above 201% of the FPL will not be required to pay premiums when the adults in the household are paying premiums in an extension. If the parents enter a restrictive re-enrollment period (RRP) for failure to pay a premium or are otherwise ineligible, non-exempt children with income above 201% will be required to pay a premium.
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