26.1 Renewals

26.1.1 Renewals Introduction
26.1.2 Three-Month Late Renewals

26.1.2.1 Verification Requirements for Late Renewals
26.1.2.2 Gaps in Coverage

26.1.1 Renewals Introduction

A renewal is the process during which you reexamine all eligibility factors subject to change and decide if eligibility continues. The group’s continued eligibility depends on its timely completion of a renewal. Each renewal results in a determination to continue or discontinue eligibility. The first required eligibility renewal for a BadgerCare Plus case is 12 months from the certification month, except for:

CENS - The renewal date is 12 months from the date of birth.
Pregnant women -The renewal date is two calendar months after the date the pregnancy ends.

Note: Women in the BadgerCare Plus Prenatal Program lose eligibility on the date the pregnancy ends. However, they are automatically eligible for emergency services for two months after eligibility for BadgerCare Plus Prenatal Program ends (see Section 41.6 BadgerCare Plus Prenatal Eligibility End Date).

Deductibles - A renewal is not scheduled for a case that did not meet its deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan., unless someone in the case was open for BadgerCare Plus. For cases that did meet the deductible, the renewal date is six months from the start of the deductible period.

Note: For manually certified BadgerCare Plus cases, make sure the member receives a timely notice of when the renewal is due.

Agency Option

BadgerCare Plus members are required to complete a renewal no earlier or no later than 12 months from their certification period. Individuals whose benefits are time-limited, such as CENs or pregnant women, will not be required to do a renewal at the end of their time limited benefit if the individual is on a case with other open BadgerCare Plus assistance groups.

Workers can complete an early renewal only if the member requests an early renewal. Once the member requests an early renewal, the renewal must be completed.

Note: Shortening certification periods in an attempt to balance agency workload is not permissible.

26.1.2 Three-Month Late Renewals

Most health care renewals received within three months of the renewal month can be processed as a late renewal instead of requiring a new application. This policy applies to the following subprograms:

BadgerCare Plus.
Family Planning Only Services (FPOS).
Elderly, Blind or Disabled Medicaid (EBD MA).
Home and Community Based Waivers (HCBW).
Institutional Medicaid.
Medicaid Purchase Plan (MAPP).
Medicare Savings Programs (QMB/SMLB/SLMB+/QDWI).

The policy applies to members receiving health care benefits based on a met deductible, but not to members with an unmet deductible.

Late renewals are only permitted for individuals whose eligibility has ended because of lack of renewal, and not for other reasons. Members whose health care benefits are closed for more than three months because of lack of renewal must reapply.

Agencies should consider late submission of an online or paper renewal form, or a late renewal request by phone or in person, to be a valid request for health care. The new certification period should be set based on the receipt date of the signed renewal. If verification is required during the completion of a late renewal, the member will have 10 days to provide it.

Example 1: Jenny’s renewal is due on January 31, 2015. She submits an online renewal via ACCESS on March 15, 2015. If the renewal is processed on the same day, and verification is requested, the verification will be due on March 25, 2015. If she provides verification on or before this due date and meets all other eligibility criteria for BadgerCare Plus, her eligibility and certification period will start on March 1, 2015. Her next renewal will be due February 28, 2016.

Note: The three-month period starts from the month the renewal was due. It does not restart when a late renewal has been submitted. If Jenny submits her renewal on March 15 but does not provide verification until May, she will need to reapply after the three-month period that started with her January renewal date.

26.1.2.1 Verification Requirements for Late Renewals

If the BadgerCare Plus renewal was completed timely, but requested verifications were not provided as part of the renewal, BadgerCare Plus can reopen without a new application if these verifications are submitted within three months of the renewal month. The submission of the renewal-related verifications is considered a request for health care. Only the missing verifications must be provided. However, the verifications must include information for the current month of eligibility. If verification is submitted for a past month, a new Verification Checklist (VCL) must be generated to request the current verification, allowing 10 days to submit the verification.

Example 2: Jenny’s renewal is due on January 31, 2015. She completes her renewal on January 20, 2015, and a VCL is generated requesting income verification for the 30 days prior to January 20. Jenny does not submit the requested verification, and her BadgerCare Plus eligibility is terminated as of January 31, 2015. On April 27, 2015, she submits her paystubs for April 10 and April 24. If she meets the eligibility criteria for BadgerCare Plus, her certification period will start on April 1, 2015, and her next renewal will be due March 31, 2016. If she had submitted the verification of her income for January, a new VCL should be generated asking for verification of her current income for April.

26.1.2.2 Gaps in Coverage

If a member has a gap in coverage because of his or her late renewal, he or she may request coverage of the past months in which the gap occurred. Backdated coverage under the late renewal policy is available to all BadgerCare Plus members who meet program rules, including children who would not otherwise qualify for backdated coverage because their income is too high (see Chapter 25.8.1). However, this does not change the rules for backdating at application.

If a member requests coverage for past months during a late renewal, he or she must provide all necessary information and verifications for those months (including verification of income for all months requested) and must pay any required premiums to be covered for those months.

This page last updated in Release Number: 17-01

Release Date: 04/11/2017

Effective Date: 04/11/2017