22-01 Version of 28.1 Overpayments Introduction

An overpayment occurs when BadgerCare Plus benefits are paid for someone who was not eligible for them or when a member should have paid a higher amount of premiums. The dollar amount of an overpayment is the amount of the BadgerCare Plus benefits incorrectly provided or the amount of underpaid premiums, whichever is less.

Overpayments can only be recovered if the member received a benefit they weren’t entitled to receive, more benefits than they were entitled to receive, or a lower premium than they should have been charged because the member did one or more of the following:

Provided incorrect or incomplete information at application
Provided incorrect or incomplete information at renewal
Failed to report a change they were required to report

Overpayments not caused by the member, including overpayments caused by the agency, system issues, or timely notice requirements, can’t be recovered.

If a member fails to correctly report income or a change in income which results in monthly income that makes the member ineligible, an overpayment doesn’t exist if the member could have been eligible under gap filling rules (see Section 28.3.4 Gap Filling Eligibility Considerations).

Use the best available information to determine whether an overpayment exists in situations where verification has been requested but has not been provided (see Section 9.8 General Rules).

This page last updated in Release Number: 22-01
Release Date: 04/04/2022
Effective Date: 04/04/2022

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