State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
BadgerCare Plus eligibility begins the first day of the month in which the valid application is submitted and all eligibility requirements are met, with the following exceptions. For these exceptions, begin dates are the date a valid application is submitted, all eligibility requirements are met, and:
All pregnant women, except those eligible under the BadgerCare Plus Prenatal program, may have their eligibility backdated to the first of the month, up to three calendar months prior to the month of application. All former foster care youth that meet the criteria in Chapter 11 Foster Care Medicaid may have their eligibility backdated to the first of the month, up to three calendar months prior to the month of application.
Children determined eligible for BadgerCare Plus are eligible for the following periods of backdated eligibility:
Infants less than 1 year old may have their eligibility backdated up to the first of the month, three calendar months prior to the month of application for any of the months in which their family income was at or below 306% FPL,
Children ages 1 through 5 may have their eligibility backdated up to the first of the month, three calendar months prior to the month of application for any of the months in which their family income was at or below 191% FPL, and
Children ages 6 through 18 may have their eligibility backdated up to the first of the month, three calendar months prior to the month of application for any of the months in which their family income was at or below 156% FPL.
All non-pregnant, non-disabled parents and caretakers may have their eligibility backdated up to the first of the month, three calendar months prior to the month of application for any of the months in which their family income was at or below 100% FPL.
Childless adults with assistance group income under 100% FPL are eligible for backdating. When backdating BadgerCare Plus, do not go back further than the first of the month, three months prior to the application month. Certify the person for any backdate month in which he or she would have been eligible had he or she applied in that month. In the case of children, certify the person for any backdate month in which he or she would have been eligible had he or she applied in that month and in which their assistance group income was at or below the appropriate FPL level for their age group. When determining backdated eligibility, use actual non-financial information (e.g. household composition) and actual income in the backdated months. A backdate request can be made at any time, except in the case where the member is already enrolled and backdating the member’s eligibility would result in a deductible for the backdated period. If a member has incurred a bill from a BadgerCare Plus certified provider during a backdate period, instruct the member to contact the provider to inform them to bill BadgerCare Plus. The member may be eligible to receive a refund, up to the amount already paid to the provider.
Example 1: Mary, who is pregnant with an August due date, applied for BadgerCare Plus on April 6, and was found eligible. At the time of application, Mary did not request a backdate. In September, Mary is billed for a doctor’s appointment she had at the end of February. Mary can ask to have her eligibility backdated through February. She meets all nonfinancial and financial eligibility criteria in the months of February and March. Her worker certifies her for BadgerCare Plus for both months. |
Eligibility for FPOS begins on the first of the month of application, if all nonfinancial (Section 40.4 Nonfinancial Requirements) and financial (Section 40.5 Financial Requirements) eligibility requirements are met. FPOS may be backdated up to three months prior to the month of application.
Except for those women eligible only under the BadgerCare Plus Prenatal Program, backdate a pregnant woman to whichever is more recent:
See Section 41.5 BadgerCare Plus Prenatal Program Eligibility Begin Date for BadgerCare Plus Prenatal Program eligibility begin date policy.
This page last updated in Release Number: 17-04
Release Date: 12/13/2017
Effective Date: 12/13/2017
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