State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

23-02 Version of 39.1 Emergency Services Introduction

BadgerCare Plus Emergency Services is a limited BadgerCare Plus benefit for documented immigrants who have not been in the U.S. for five years or more and for undocumented immigrants.

An immigrant who is ineligible for BadgerCare Plus because of their immigration status is eligible for BadgerCare Plus Emergency Services coverage if they:

1. Meet the income limits listed in Section 39.1.1 Emergency Services Income Limits.
2. Meet all other BadgerCare Plus eligibility requirements, except having or applying for an SSNSocial Security number.
3. Qualify for coverage under a BadgerCare Plus category other than that for childless adults (see Section 39.1.2 Emergency Services Special Rules)

A person can be eligible for Emergency Services for an emergency that occurred within the three months prior to the application month as long as the person met the eligibility requirements for Emergency Services during the month(s) in which the emergency occurred.

An emergency means a medical condition (including labor and delivery) that shows acute symptoms of sufficient severity (including severe pain) such that the lack of immediate medical treatment could result in one or more of the following:

1. Serious jeopardy to the patient's health.
2. Serious impairment to bodily functions.
3. Serious dysfunction of a bodily organ or part.

BadgerCare Plus Emergency Services covers:

1. Only those medical services needed for the treatment of an emergency medical condition.
2. All labor and delivery services for eligible non-qualifying immigrants.

For information on manually processing applications, see Process Help, Section 9.3 BC+ Emergency Services Manual Application Processing.

39.1.1 Emergency Services Income Limits

Group	Income
Pregnant Women	Up to 306% FPL
Newborns to age 1	Up to 306% FPL
Children ages 1 - 5	Up to 191% FPL
Children ages 6 - 18	Up to 156% FPL
Former Foster Care Youth	Any FPL Level
Parents and Caretakers	Up to 100% FPL

 

Note

These income limits must be applied because not everyone who meets the rules for BadgerCare Plus qualifies for BadgerCare Plus Emergency Services. Emergency Services is funded through the Medicaid Program (T-19), and is only available for people whose coverage is provided under a Medicaid state plan. As a result, children above the income limits for Medicaid (T-19) and childless adults whose coverage is provided under a federal waiver do not qualify for Emergency Services.

39.1.2 Emergency Services Special Rules

A U.S. citizen is not eligible for BadgerCare Plus Emergency Services even when they cannot produce citizenship verification, identity verification, or both.

Example 1

Jill applies for BadgerCare Plus, declares U.S. citizenship and is asked to provide documents proving her citizenship and identity. She has a driver license to prove identity but does not have anything to prove her citizenship. Since Emergency Services BadgerCare Plus does not require proof of citizenship and identity as an eligibility requirement, she then asks to be considered for this program. However, the IM worker cannot process BadgerCare Plus Emergency Services eligibility for persons declaring to be U.S. citizens. BadgerCare Plus Emergency Services is reserved for non-qualifying non-citizens.

Verification of identity is not required if the applicant or member is not a U.S. citizen.

Immigrants who only meet the criteria for BadgerCare Plus under the childless adults’ coverage group are ineligible for Emergency Services.

An inmate who is a non-qualifying immigrant may be eligible for Emergency Services for the dates they are hospitalized as an inpatient for emergency treatment as long as they meet the rest of the eligibility criteria for Emergency Services.

Pregnant non-qualifying immigrantsNon-qualifying immigrants are individuals that are not eligible for BC+ due to immigration status. may be eligible under the BadgerCare Plus Prenatal Program.

39.1.3 Emergency Services and Public Charge

Emergency Services is not considered in public charge determinations (see Section 4.3.4 Public Charge).

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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