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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
This page last updated in Release Number: 20-04
Release Date: 11/23/2020
Effective Date: 11/23/2020
Childless adults are subject to a household premium of $8 a month unless they are exempt for any of the following reasons:
Members will not be subject to premiums for backdated months.
Childless adults may qualify for a premium-free month under both of the following conditions:
The premium requirement will apply for new applications with a filing date on or after February 1, 2020.
For renewals, when the premium requirement will apply depends on the status of the renewal:
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Example 1: Jane was a childless adult enrolled in BadgerCare Plus with a renewal due December 31, 2019. Jane did not renew her benefits on time, so her BadgerCare Plus closed. On February 20, 2020, Jane submits a late health care renewal to regain eligibility as of January 1, 2020. Because Jane is submitting a late renewal after February 1, 2020, she will be subject to the new premium requirement. However, because the requirement did not go into effect until February 1, 2020, Jane will not owe a premium for the month of January. Jane will begin to owe monthly premiums as of February 2020, unless she qualifies for any exemption. |
| Example 2: Mary is a childless adult currently enrolled in BadgerCare Plus. Her certification period began in October 2019. Mary will not be subject to the new premium requirement until she renews her health care benefits in September 2020 and her new certification period starts, if she remains a childless adult and does not qualify for any exemption. |
The premium requirement will apply if a health care member becomes a childless adult during a certification period that starts after the policy effective date. This includes the member joining an existing childless adult assistance group.
| Example 3: James and Beth are currently enrolled in BadgerCare Plus as parents, along with their 18-year old daughter, Sara. Their certification period began in June 2019. They complete a renewal in May 2020. Because they are parents, the premium requirement does not apply to James and Beth at the time of renewal. Sara turned 19 in July 2020, so James and Beth become childless adults. Because their certification period began after February 1, 2020, James and Beth will begin to owe monthly premiums upon this change (unless they qualify for any exemption). |
If the household income rises above 50% of the FPL due to a change in income or household composition, the premium payment requirement will apply the following month (subject to timely notice requirements).
If the household income drops to 50% of the FPL or less, then the premium payment requirement will no longer apply as of the same month in which the change in income was reported.
The monthly premium is assessed at the household level, not the individual level. The monthly premium amount is $8 regardless of household size. However, this amount can be lowered during the certification period based on healthy habits reported through response(s) to the health survey, or by the response(s) to the treatment needs question by childless adults in the household. The reductions for the monthly premium are as follows:
| Premium Amount | Applicable Reductions |
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$4 |
One-person household with that person receiving a reduction |
| Two-person household with both people receiving a reduction | |
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$6 |
Two-person household with only one person receiving a reduction |
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$8 |
One- or Two-person household with no reduction for the household |
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Example 4: There are two childless adults in the household: Alice and Barry. The household pays a $6 monthly premium because Alice took the health survey and reported healthy habits, but Barry did not. Their certification period began April 1, 2020.
Alice suffers injuries in a car accident in June 2020. Subsequently, she is verified disabled effective July 2020 and becomes eligible for EBD Medicaid.
Because Alice is no longer a childless adult, her health survey response does not result in a premium reduction for the household. Barry’s household premiums will increase to $8 but he could reduce that amount to $4 if he completes the health survey and shows that he has healthy habits. |
Reductions based on the health survey or treatment needs question apply as of the month the health survey or treatment needs question was received. However, if a health survey is submitted within the first two months of the certification period, any premium reductions will be retroactively applied back to the beginning of the certification period.
Like other health care premiums, the premium that childless adults pay for BadgerCare Plus will be due on the 10th day of the benefit month. However, failure to pay the premium will not result in disenrollment until the end of the certification period. Premiums are tied to the certification period, not the calendar year. Any accrued premium amount the childless adult has not paid will result in disenrollment at the following times:
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Example 5: Aaron applies for BadgerCare Plus in March 2020. He is a childless adult with no applicable exemption and an income over 50% of the FPL. This is the first time he has applied for a health care benefit. He does not receive a reduction for the monthly premium amount.
The month of March 2020 is premium-free for Aaron. Over the next 10 months, he does not pay any premiums.
In January 2021, Aaron submits an early renewal for BadgerCare Plus. He will need to pay his entire $80 arrears ($8 monthly premium x 10 months (April 2020 – January 2021)) to remain eligible for BadgerCare Plus as of February 2021. |
Members cannot pre-pay monthly premiums. They can pay each month, pay multiple owed months, or wait until the end of the certification period to pay. For example, if the certification period is February 2020 through January 2021, the member cannot pay in advance for future months on February 15, 2020. Instead, the member can:
Premium statements will be sent to childless adults monthly. The statement will display the following information:
A mail-in section will be provided for members to include with their check or money order.
Childless adults will have several options to pay the monthly premiums:
Childless adults will be able to pay using a credit or debit card, or pay by EFT from a checking or savings account, through the ACCESS website or MyACCESS mobile app. Members may mail in a check or money order as payment, but only when the premium payment is a condition of eligibility (for example, at renewal) can the member submit a check or money order directly to the IM agency.
The childless adult will enter a six-month RRP when there are unpaid premiums at the end of the certification period. During the RRP, the childless adult must pay the full amount of unpaid premiums to have benefits reinstated. The childless adult can also regain eligibility if they meet an exemption (for example, they become homeless), their income has dropped to 50% or less of the FPL, or they become eligible under a different category of Medicaid. If one of these three conditions applies, the RRP would run in the background in case their situation changes (for example, they later regain eligibility as a BadgerCare Plus childless adult, or their income increases to more than 50% of the FPL).
When the childless adult chooses not to pay the full amount during the RRP, he or she must wait until the RRP ends to re-request health care benefits. At the end of the six-month RRP, the arrears on the unpaid premiums are no longer required. At application, the member may ask for backdated eligibility (up to 3 months), even if those months overlap with the completed RRP. In any case, the member is not subject to premiums for backdated months.
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Example 6: Kim applies for BadgerCare Plus in January 2021 and has a monthly premium set at $8. She is enrolled but does not pay the premiums for January, February, March, April, and May.
Kim reports that she has moved to Minnesota on May 9, 2021. Her benefits end May 31, 2021, and a six-month RRP is established for June through November 2021.
Kim moves back to Wisconsin in July 2021. She reapplies for BadgerCare Plus and the worker pends eligibility to obtain the outstanding premiums. If Kim chooses not to pay the premiums by the due date, her application will be denied due to the existing RRP. She decides to pay the arrears incurred in early 2021 and her application is approved. However, she could have chosen to forgo coverage until December 2021 when she could reapply and enroll in BadgerCare Plus without paying the arrears. |
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Example 7: Ben applies for BadgerCare Plus in January 2021 and has a monthly premium set at $4. He is enrolled but does not pay the premiums for January, February, March, and April.
Ben enters a nursing home in May 2021. He stays more than 30 days and qualifies for Institutional Medicaid. His BadgerCare Plus certification period ends and his Institutional Medicaid certification begins on May 1, 2021. Because Ben’s BadgerCare Plus certification ended, and he had unpaid premiums, a six-month (May 2021 to October 2021) RRP will be established and run in the background.
Ben reports that he returned home on July 8, 2021. The worker updates the case and BadgerCare Plus pends eligibility to obtain the outstanding premiums. If he pays the arrears, he would become eligible for a new certification period as a childless adult as of August 2021. However, if he chooses not to pay the arrears, he will fail due to an RRP until he pays his premiums from the previous BadgerCare Plus certification period (January-April 2021), or until the RRP expires. |
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Example 8: Aaron applies for BadgerCare Plus in March 2020 and has a monthly premium set at $8.
The month of March 2020 is premium-free for Aaron. Over the next 10 months, he does not pay any premiums. On January 10, 2021, Aaron submits an early renewal for BadgerCare Plus, during which he reports his income is less than 50% of the FPL.
Aaron is not be required to pay monthly premiums for the certification period beginning February 2021, and he would remain enrolled in BadgerCare Plus. However, he would have an RRP in the background for payment on his $80 arrears ($8 monthly premium x 10 months). If his income increased to more than 50% of the FPL during the RRP, he would no longer be eligible for BadgerCare Plus until he pays all of his arrears, or until the RRP expired. |
Note: Childless adults will not be notified or automatically re-enrolled in health care at the end of the RRP. Instead, the notice that informs the member that he or she has entered an RRP will state the length of the RRP.
Refunds of childless adult premiums are based on the current policy regarding refunding BadgerCare Plus premiums:
The refund will always be paid to the member regardless of who paid the premium. Refunds will always be paid in the form of a check.
Information on the required premium payments for childless adults will be included in the Notice of Decision. The Notice of Decision will also include information on an RRP if applicable.
This page last updated in Release Number: 20-04
Release Date: 11/23/2020
Effective Date: 10/24/2020
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