State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
A pregnant woman with assistance group income over 306% of the FPL must meet a deductible to become eligible for BadgerCare Plus.
For a pregnant woman, the deductible amount is the amount of countable income above 300% of the FPL for a six-month period. To meet the deductible, the pregnant woman or other family members included in the BadgerCare Plus assistance group must incur medical bills equal to the pregnant woman's deductible amount.
Note |
If there is more than one pregnant woman in the BadgerCare Plus assistance group, all of them become eligible when a deductible is met. |
If the pregnant woman applies before the birth of the baby and meets the deductible while pregnant, she remains eligible for BadgerCare Plus for the rest of the pregnancy and through the end of the month in which the 60th day following the end of the pregnancy falls. She remains eligible for this period as a pregnant woman regardless of when the deductible period ends.
If the pregnant woman applies after the birth of her baby and becomes eligible by meeting a deductible in backdated months, she is only eligible as a pregnant woman until the end of the month the pregnancy ends.
(For eligibility regarding the BadgerCare Plus Prenatal Program for inmates of a public institution or non-qualifying immigrants, see Section 41.2 BadgerCare Plus Prenatal Program Eligibility Requirements).
Example 1 | Janet gives birth on June 30. On July 10, she applies for BadgerCare Plus and requests a BadgerCare Plus deductible period from April through September. Janet paid the full deductible amount, so is certified from April 1 through June 30 (the end of the month in which her pregnancy ended). She should be tested as a parent / caretaker relative effective July 1 if she is living with the newborn or any other child under her care, or if applicable, as a childless adult or under Medicaid for the Elderly Blind or Disabled. |
Example 2 | Annette applies for BadgerCare Plus as a pregnant woman in May and requests a BadgerCare Plus deductible period from April to September. She gives birth on June 14. Annette paid the full deductible amount and applied prior to the birth of the baby, so she is certified from April 1 through August 31 (the month in which the 60th day following the end of the pregnancy falls). She should be tested as a parent / caretaker relative effective September 1 if she is living with the newborn or any other child under her care, or if applicable, as a childless adult or under Medicaid for the Elderly Blind or Disabled |
The pregnant woman can choose to begin the BadgerCare Plus deductible period as early as three months prior to the month of application , and as late as the month after the month of application.
A pregnant woman can choose a BadgerCare Plus deductible period which includes a month in which she is ineligible for a non-financial reason, with one exception. A deductible period may not begin with a month in which the pregnant woman is non-financially ineligible.
Although excess income is still calculated over a six month period, the individual may only be certified for BadgerCare Plus during the dates when she is non-financially eligible.
Example 1 | Luanne applied for BadgerCare Plus as a pregnant woman on June 1 and requested a BadgerCare Plus deductible period from April through September. She gave birth on June 2. Luanne paid the full deductible amount, so is certified from April 1 through August 31 (the month in which the 60th day following the end of the pregnancy falls). Even though the deductible period continues through September, Luanne will remain eligible through September 30 only if she is otherwise nonfinancially eligible for a deductible. For example, if she becomes disabled or pregnant again. If she is non-financially eligible for a deductible, she should be tested as a parent/caretaker relative effective September 1 if she is living with the newborn or any other child under her care, or if applicable, as a childless adult or under Medicaid for the Elderly Blind or Disabled |
A new deductible period can be established at any time before the current deductible has been met. The person must sign and submit a new application in order for the new deductible period to be established.
Example 2 |
Julie is pregnant and due November 15. She applied for BadgerCare Plus April 1. She is eligible for a deductible period from April 1 through September 30. She has not incurred enough expenses to meet the deductible. In July, Julie’s income decreased, and she would like to have a new deductible period from July 1 through December 31. Julie must submit a new, signed application for the IM agency to establish a new deductible period. |
A pregnant woman who is ineligible due to excess income in some backdated months, but has no excess income in others, does not have to choose to have a BadgerCare Plus deductible. She can choose to be certified in the months she is eligible and to accept the ineligibility of the other months when she had excess income.
Example 3 |
Rachel is pregnant and applied for BadgerCare Plus in July. She had no income and did not expect any income in the future. She was eligible in July. She also requested BadgerCare Plus eligibility for April to cover some medical expenses she had in April. In April and May, she had income in excess of 300% of the FPL. In June, she would have been eligible because she had no income. In April and May, her income was over 300% of the FPL by $200 a month. She has two choices:
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To calculate the dollar amount of the BadgerCare Plus deductible for a pregnant woman:
When calculating a deductible amount for backdated months, use the actual, not prospective, income received in the backdated months.
This page last updated in Release Number: 21-03
Release Date: 12/13/2021
Effective Date: 12/13/2021
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