State of Wisconsin Department of Health Services

Release 26-02 April 15, 2026

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11.1 Out-of-Home Care (Foster Care)

Children or youth in any of the following placements or agreements are eligible for Foster Care Medicaid without applying:

• Out-of-Home (Foster Care) 
• Active Subsidized Guardianship Agreement
• Court-ordered Kinship Care
• Long term Kinship Care
• Active Adoption Assistance Agreement

Certifications for Foster Care Medicaid are not the responsibility of the IMincome maintenance agency. Child welfare agencies certify eligibility for Foster Care Medicaid when a child has been removed from the home.

11.1.1 Foster Care Medicaid Certification

Eligibility for Foster Care Medicaid begins on the date the child or youth was removed from the home, which can be any date of a month. 
 
Children or youth certified for Foster Care Medicaid, who remain in placement at the end of their certification period, are granted a new 12-month certification period. See Section 1.2.8 Foster Care Medicaid regarding continuous coverage for children. 

11.1.2 Foster Care Medicaid Disenrollment

When a child getting Foster Care Medicaid leaves their out-of-home placement, or their Subsidized Guardianship or Adoption Assistance agreement ends, they remain eligible under Foster Care Medicaid for the remainder of their 12-month continuous coverage period or three months after their placement or agreement ends, whichever is later.

Children who are 19 or older receive a 3-month grace period but their continuous coverage period concludes at the end of the month they turn 19. 

Example 1

Remmy is 18, he will turn 19 in July. Remmy has Foster Care Medicaid. His current certification period is July 1 through August 31. His court-ordered Kinship Care agreement ends on June 20. Remmy’s will continue to have Foster Care Medicaid until Sept 30. This is because Remmy must have a minimum of three complete months of Foster Care Medicaid after his agreement end date,.

Example 2

Karmi is 18, they will turn 19 in January. Karmi has Foster Care Medicaid, and their certification period is April 1 through March 31. Their placement ends on June 20. Karmi will continue to have Foster Care Medicaid until January 31. This is because Karmi can stay in their continuous coverage period until the end of the month in which they turn 19.

Example 3

Meg has Foster Care Medicaid. Their current Foster Care Medicaid certification period is May 1 through June 30. Their placement ends on February 20. Meg turns 19 on August 15. Meg will continue to have Foster Care Medicaid until June 30. Meg keeps her continuous coverage period because she remains under age 19.

After a child leaves their out-of-home placement or their Subsidized Guardianship, or their Adoption Assistance agreement ends, Foster Care Medicaid eligibility must be maintained manually (see Process Help 9.6.2.3 IM Agency Role) until one of the following occurs: 

• The child or youth is determined eligible for another category of Medicaid or BadgerCare Plus.
• The child or youth is determined ineligible for all categories of Medicaid and BadgerCare Plus.
• The child, youth, or family failed to provide the required information to complete an eligibility determination or chooses not to pursue other Medicaid benefits.
• The child or youth dies or leaves Wisconsin.

When the child or youth is discharged from out-of-home care, or their Subsidized Guardianship or Adoption Assistance agreement ends, the IM agency must redetermine the child or youth’s health care eligibility with assistance from the child welfare agencies, when needed. The IM agency should set up a formal communication process with the child welfare agency to ensure IM agencies are made aware of all children leaving the Foster Care system and are provided with information necessary to redetermine eligibility. To prevent children from losing eligibility entirely, the Department of Health Services and Department of Children and Families have set up a process to send communication to families or share information with the IM agency. See Process Help, Section 9.6 Youths Discharged from Out-of-home Care and Updated All FFYC Processes for more information.

The IM agency must determine eligibility for the youth or child as of the date the child returned to the home. If the youth or child is determined eligible, a Notice of Decision must be sent. If the IM agency does not have sufficient information to redetermine Medicaid eligibility, the agency must request needed information from the individual or family.

If the individual or family does not comply with a request for information after 30 days, or if the youth or child is determined ineligible, a Notice of Decision must be sent denying BadgerCare Plus or Medicaid eligibility for the appropriate reasons.

If the child or youth has not obtained other full benefit health care coverage, the state will send notice of Foster Care Medicaid ending approximately three months in advance, but at least 10 days before the Foster Care Medicaid end date.

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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