17.1 Deductibles

Children (younger than 19 years old) with income over 306% of the FPLFederal Poverty Level may become eligible for BadgerCare Plus by meeting a deductible. Children with income over 156% of the FPL who are denied BadgerCare Plus solely due to access to health insurance may also become eligible for BadgerCare Plus by meeting a deductible. The deductible amount is calculated for a six-month period using the amount of income that exceeds 150% of the FPL.

Pregnant women with incomes above 306% of the FPL can qualify for BadgerCare Plus by meeting a deductible. The deductible amount is calculated for a six-month period using the amount of income that exceeds 300% of the FPL for pregnant women. The deductible is met by incurring medical expenses that equal the deductible amount. Pregnant women who could only qualify for the BadgerCare Plus Prenatal Program may not become eligible for the Prenatal Program by meeting a deductible.

Note

When determining the deductible amount, only the income of the applicant, the applicant's spouse, and, if the applicant is younger than 19 years old, the applicant’s parents, should be considered. If a sibling or other tax dependent has been counted as part of the applicant’s regular MAGI assistance group, the sibling's or tax dependent's income should be excluded for purposes of calculating the deductible; however, they should still be included in the assistance group size.

This page last updated in Release Number: 17-03
Release Date: 08/21/2017
Effective Date: 04/11/2017

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