20-04 Version of 19.1 BadgerCare Plus Premiums for Children

Children in families with income over 201% of the FPLFederal Poverty Level must pay a premium to become or remain eligible for BadgerCare Plus unless exempt. This includes children who are open for regular BadgerCare Plus (not an extension) but whose parents, caretakers, or siblings are in a BadgerCare Plus extension.

Example 1

Roger lives with his son, Sam, and they are open for BadgerCare Plus under an extension. Neither of them have a premium since they are both in an extension. In October, Roger’s other son, Justin, moves into the household. Justin is determined eligible for regular BadgerCare Plus as a child because he does not meet the requirements to be eligible under the extension with Roger and Sam. Roger and Sam continue to be eligible under the extension and do not have a premium. The household income is 230% of the FPL. Justin has a premium of $10.

If Justin’s premium is not paid, he will go into an RRP. Roger and Sam continue to be eligible under the extension.

The following children are exempt from the requirement to pay a premium for BadgerCare Plus:

Pregnant minors,
Former Foster Care Youth (see Chapter 11 Foster Care Medicaid),
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,
Children in a BadgerCare Plus extension,
All children under age 1 including Continuously Eligible Newborns (see Section 8.2 Continuously Eligible Newborns),
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,
Children whose BadgerCare Plus is suspended due to being incarcerated in jail or prison.

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.

Information about premiums and restrictive re-enrollment periods (RRP) for childless adults can be found in Section 44.2 Premiums for Childless Adults.

This page last updated in Release Number: 20-04
Release Date: 11/23/2020
Effective Date: 10/24/2020