State of Wisconsin Department of Health Services

Release 24-02 August 22, 2024

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2.1 BadgerCare Plus Nonfinancial Requirements 

Wisconsin residents in the following coverage groups may be non-financially eligible for BadgerCare Plus:

• Children younger than 19 years old
• Pregnant persons
• Parents and caretakers of children younger than 18 years old and dependent 18-year-olds
• Parents and caretaker relatives whose children have been removed from the home and placed in out-of-home care
• Former Foster Care Youth younger than 26 years old who were in out-of-home care when they turned 18
• Adults ages 19-64 who are not receiving Medicare, except Medicare Part B Immunosuppressive Drug Benefit (Part B-ID), and who do not have dependent children who reside with them at least 40% of the time.

To be eligible for BadgerCare Plus, a person must meet the following criteria:

• Be a Wisconsin resident (see Chapter 3 Residence)
• Be a U.S. citizen or qualified immigrant (see Chapter 4 Citizen and Immigration Status)

Note	A non-qualifying immigrant receiving BadgerCare Plus Emergency Services (see Chapter 39 Emergency Services) or a BadgerCare Plus Prenatal Program applicant (see Chapter 41 BadgerCare Plus Prenatal Program) is not required to be a U.S. citizen or qualified immigrant.

• Provide documentation of citizenship and identity or of immigration statusThe legal status conferred on a non-citizen by immigration law (see Section 4.1 U.S. Citizens and Nationals)
• Cooperate with establishing medical support and Third Party Liability (TPL) (see Chapter 5 Medical Support and Third Party Liability)
• Sign over to the state their rights to payments from a third party for medical expenses (see Section 5.2 Medical Support/CSA Cooperation)
• Meet BadgerCare Plus Social Security Number (SSN) requirements (see Chapter 6 Social Security Requirements)
• Cooperate with verification requests when information is mandatory or deemed questionable (see Chapter 9 Verification)
• Meet health insurance access and coverage requirements (see Chapter 7 Health Insurance Access and Coverage Requirements)

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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.

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