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 member 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.

Pregnant Children

When a pregnancy is reported for a child under age 19 on a case, they will have continuous coverage through at least the end of the postpartum period or the end of their 12-month continuous coverage period, whichever is later.

Example 2

Marita and her 16-year-old daughter Lupita have been enrolled in BadgerCare Plus since January 2024. In April 2024, they report that Lupita is pregnant with a due date of January 25, 2025. Lupita moves from MAGC to MAGP effective May 1, 2024. Lupita's continuous coverage end date is updated to March 31, 2025, the end of the postpartum period. In December 2024, Marita completes a renewal and has a new certification period established from January 1, 2025, to December 31, 2025. Lupita delivers a baby January 13, 2025. The baby is enrolled in BadgerCare Plus as a continuously eligible newborn (MAGB) through January 31, 2026. Lupita remains enrolled in MAGP until the end of the postpartum period. In response to a worker alert, the IM agency determines eligibility for Lupita and transitions her from MAGP to MAGC from April 1, 2025, until Marita's renewal date of December 31, 2025.

If a child under age 19 applies as a pregnant minor on their own case, and they are initially enrolled in BadgerCare Plus as a pregnant individual (MAGP), they will get their 12-month continuous coverage period as a pregnant individual. It will not end when their postpartum period ends. When the pregnancy ends, they will be tested for other benefits (for example, they may transition to coverage as a child or a parent/caretaker), but if they do not qualify for another category of health care, they will remain enrolled in BadgerCare Plus as a pregnant individual for the rest of their 12-month continuous coverage period for children.

Example 3

Jordan is 17, pregnant, lives on their own, and is not claimed as a tax dependent. Jordan applied for BadgerCare Plus in May. Jordan is due in November. Jordan is determined eligible for BadgerCare Plus as a pregnant individual. Because they are under age 19 and are applying on their own case, they will be enrolled in BadgerCare Plus for a 12-month certification and continuous coverage period from May 1 to April 30. When Jordan's pregnancy ends, they can transition to other benefits if they meet program rules, but otherwise, they will remain enrolled in MAGP through April 30.

If the pregnant child turns 19 during the pregnancy or postpartum period, they remain entitled to their continuous coverage as a pregnant person.

Example 4

Lynn and her children, Bailey and Taylor, are open for BadgerCare Plus. A pregnancy is reported for Taylor, and they are transitioned to BadgerCare Plus for a pregnant individual as of September. The pregnancy ends due to miscarriage on December 5. Taylor turns 19 on January 2. They remain eligible for the rest of the postpartum period.

This page last updated in Release Number: 24-01
Release Date: 04/03/2024
Effective Date: 01/01/2024