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State of Wisconsin |
Release 24-03 |
On December 29, 2022, the Consolidated Appropriations Act, 2023, was signed into law. This legislation requires that children in certain Medicaid programs and the Children’s Health Insurance Program (CHIP) are provided with 12 months of continuous health care coverage, with some limited exceptions, effective January 1, 2024. Continuous coverage means that the child will not lose coverage during that time period, even if the family’s situation changes.
Effective January 1, 2024, most children under age 19 enrolled in BadgerCare Plus and Medicaid programs will have 12 months of continuous coverage, starting with the month of their health care application, new certification period at renewal, or when the child otherwise becomes eligible under a qualifying group. This also applies when a new child under 19 is added to a case that already has a child with 12 months of continuous coverage.
| Example 1 | Jane applies for health care for her and her son Sam on January 17, 2024, with a three month backdate, and they are determined eligible for BadgerCare Plus as of October 1, 2023. Sam will have continuous coverage from January 1 through December 31, 2024. If the household has a change in circumstances during the certification period, Jane may lose coverage, but Sam will remain eligible through December 31, 2024. |
| Note | Backdated months do not count toward the 12-month continuous coverage period. To qualify for a 12-month continuous coverage period, a child must be eligible for the application month and/or a following month. If a child is only eligible in a backdated month, they do not qualify for a 12-month continuous coverage period |
Children who are already members of an applicable health care program on January 1, 2024, will have a continuous coverage period that extends to their next renewal date.
| Example 2 | Juan, age 17, was enrolled in BadgerCare Plus in May 2023. He is still enrolled as of January 1, 2024, so he will have continuous coverage from January 1, 2024, to his renewal date of April 30, 2024. Even if the household reports a change and the household’s income goes above the program income limit, he will remain eligible through April 30, 2024. |
At renewal, a child must meet the program’s eligibility requirements in order to get a new 12-month period of continuous coverage.
| Example 3 | Gino is 16 and has been enrolled in Medicaid since May 2020. Gino’s renewal is due in March 2024. Because Gino is enrolled as of January 1, 2024, he also has continuous coverage until his renewal in March 2024. At renewal, Gino’s household income is over 306% of the federal poverty level. He no longer meets program rules, so his health care benefits end March 31, 2024. He does not qualify for a new 12-month continuous coverage period. |
Children under age 19 in the following programs are eligible for 12 months of continuous coverage:
Continuous coverage does not apply to children:
Qualifying children under 19 will only lose health care coverage during their 12-month period for the following reasons:
| Example 4 | Allison is 17 and enrolls in BadgerCare Plus February 1, 2024. On May 12, her household reports moving to Florida. Allison’s BadgerCare Plus ends May 31, 2024. |
| Example 5 | Margaret applies for BadgerCare Plus for her son Ricardo. Ricardo is eligible, but verification of his citizenship is still needed. Ricardo is enrolled in BadgerCare Plus as of February 1, 2024, and is given a reasonable opportunity period to verify his citizenship. Ricardo’s citizenship is not verified by the due date of May 10, 2024, so his BadgerCare Plus ends May 31, 2024. |
If a child becomes incarcerated and their eligibility is suspended, their continuous coverage will run in the background. If they are released from incarceration within the 12-month period, they will qualify for continuous coverage for the rest of the 12-month period.
If a child’s only parent or caretaker becomes incarcerated, the child will keep their health care for the rest of the 12-month period. If the child becomes eligible on another case or if they are enrolled in Foster Care Medicaid, they will get a new 12-month period of continuous coverage. See Section 1.2.8 Foster Care Medicaid.
An immigrant child enrolled in Emergency Services qualifies for a 12-month period of continuous coverage. Their enrollment is not limited to the period their provider indicates they require treatment of an emergency medical condition.
A child can have a new premium obligation at application or renewal but cannot have a new premium once their 12-month continuous coverage period starts. Existing premiums for an individual child cannot increase during their 12-month continuous coverage period, but they may be reduced if applicable. If the premium is lowered, that new amount becomes their premium cap for the rest of the 12-month period.
| Example 6 | Kiley and Korbin are enrolled in BadgerCare Plus as of July 1, 2024. They each owe a $20 premium, for a total household premium of $40. Their individual premiums of $20 cannot increase during their 12-month period. The household has a reduction in income in December 2024, and their premiums lower to $10 each. Their premiums now cannot go above $10 for the rest of the 12-month period. If the household has an increase in income at any point in their remaining certification period, their premiums will not increase. |
| Example 7 | Ryan is enrolled in BadgerCare Plus with no premium. Ryan’s continuous coverage period ends on October 31, 2024. In July, his family reports an increase in income that would result in a $20 premium for Ryan. This premium will only take place in the new certification period, starting on November 1, 2024. |
| Note | While an individual child’s premium cannot increase during their 12-month continuous coverage period, there may be instances where the household’s total premium amount does increase, like when another child is added to the household and that new child owes a premium. |
| Example 8 | Emily is enrolled in BadgerCare Plus as of June 1, 2024 with a premium of $20 for a total household premium of $20. The household reports another child, Kwan, has joined the household and he is added to the case. Kwan has a premium of $20, which would bring the new household premium to $40 |
If a child’s household has an increase in income that qualifies the parents for an earned income or spousal support extension, the child will stay in their current BadgerCare Plus assistance group while their parent(s) go into the extension.
If a child under age 19 getting Foster Care Medicaid leaves their out-of-home placement, or their Subsidized Guardianship, or Adoption Assistance agreement ends, they will keep their Foster Care Medicaid for the rest of the 12-month period, or three months after their placement or agreement ends, whichever is later.
| Example 9 | Trey enrolled in Foster Care Medicaid on February 1, 2024. His placement ends July 28, 2024. Trey will keep his Foster Care Medicaid until January 31, 2025, which is the remainder of the 12-month period. |
| Example 10 | Sally enrolled in Foster Care Medicaid on January 1, 2024. Her placement ends November 13, 2024. Sally will keep her Foster Care Medicaid until February 28, 2025 so she has three months to apply for other health care coverage. |
During the 12-month continuous coverage period, a child may not move from a Medicaid-funded category of health care to a CHIP-funded category of BadgerCare Plus (see section 51.1 BadgerCare Plus Categories). However, a child may move from a CHIP-funded category of BadgerCare Plus to a full-benefit Medicaid program. One exception to this is that a child may not move from a CHIP-funded category of BadgerCare Plus into an earned income or spousal support extension.
When an individual opens for a new health care certification period on a case, new 12-month certification periods will be established for other eligible health care members in the household, with some exceptions.
If a child would be negatively impacted or move to a CHIP category of health care because of a change, person-add, or new program request during their 12-month continuous coverage period, the child will not get a new 12-month certification period. They will remain in their current certification period. However, other household members can get new 12-month certification periods. Households may also have different health care renewal dates.
| Example 11 | Mary’s 10-year-old son Tom is enrolled in BadgerCare Plus with a $10 premium because Mary’s income is at 210% FPL. Tom’s continuous coverage period is July 1, 2024, through June 30, 2025. On December 4, 2024, Tom moves to his father Jack’s household. Jack requests health care for himself and Tom. Jack is denied due to excess income. Tom would also be ineligible due to Jack’s income being over 306% FPL. However, since Tom has an already established continuous coverage period from his mother’s case, Tom is enrolled in BadgerCare Plus on Jack’s case at 210% FPL for the remainder of his continuous coverage period, through June 30, 2025. Jack will be charged the $10 monthly premium for Tom’s coverage once Tom is enrolled on Jack’s case. |
| Example 12 | LaTanya’s 11-year-old son Tucker is enrolled in BadgerCare Plus with a $30 premium from January 1, 2025, through December 31, 2025. On February 7, 2025, LaTanya’s 8-year-old son Trey joins the household and requests health care. Trey has continuous coverage under BadgerCare Plus without a premium from his father’s case through June 30, 2025. Trey is determined eligible on LaTanya’s case and would normally have a premium based on the income and group size of LaTanya’s case. Trey will be enrolled in BadgerCare Plus without a premium for the remainder of his continuous coverage period from his father’s case, through June 30, 2025. Tucker’s premium reduces from $30 to $10 with the increased group size, and he gets a new 12-month certification period from March 1, 2025, through February 28, 2026. While Trey has a renewal date of June 30, 2025, Tucker has a renewal date of February 28, 2026. If a renewal is completed for Trey in June 2025, and Trey and Tucker are both determined eligible without adverse impact, their certification periods may align. |
This page last updated in Release Number: 24-03
Release Date: 12/18/2024
Effective Date: 12/18/2024
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.
Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.
Publication Number: P-10171