23-04 Version of 8.1 Pregnant Members

Note	This chapter does not apply to pregnant members in the BadgerCare Plus Prenatal Program.

A pregnant member who is enrolled in BadgerCare Plus stays eligible for both:

Through the end of the pregnancy.
An additional 60 days after the last day of pregnancy through the end of the month in which the 60th day occurs.

The eligibility decision does not need to be made prior to the end of the pregnancy, but the applicationA request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. must be filed before the end of the pregnancy in order for the member to remain enrolled as a pregnant member for the 60 days after the pregnancy ends. If the application is not filed before the end of the pregnancy and the applicant is living with the newborn or other children under 19, the applicant should be tested for BadgerCare Plus eligibility as a parent once the pregnancy ends. An application for Express Enrollment does not meet this application test.

A pregnant member with income over 306% of the Federal Poverty Level (FPL)Federal Poverty Level at the time of application when eligibility is first determined can become eligible for BadgerCare Plus by meeting a deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan. (see Section 17.2 Pregnant Members).

There are no premiums for pregnant members (see Section 19.1 BadgerCare Plus Premiums).

All pregnant members, except those eligible under the BadgerCare Plus Prenatal Program, may have their eligibility backdated to the first of the month up to three months prior to the month of application. If a person is determined to be eligible as a pregnant member for a backdated month, they remain eligible, even if they are over the income limit for any subsequent months, as long as they are still pregnant.

Example 1

Barb is pregnant and applied for BadgerCare Plus in December with a three-month backdate request. Barb is due in March. Her income was below 306% of the FPL for September, but over 306% for October, November, December, and ongoing. She met all of the other eligibility criteria. Since she was determined eligible as a pregnant woman for the month of September, the subsequent increase in her income is ignored and she remains eligible for BadgerCare Plus through the end of the month in which the 60th day after the last day of pregnancy occurs.

This page last updated in Release Number: 23-04
Release Date: 12/18/2023
Effective Date: 01/01/2024