17.3 Children Under 19

17.3.1 Deductible Period
17.3.2 Calculating the Deductible Amount

Children (younger than 19 years old) with income over 306% of the FPL 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.

To meet the deductible, the child or their parents included in the child’s BadgerCare Plus group must incur medical bills equal to the deductible amount. Deductible-based eligibility is not extended to other children or members of the original assistance group. The parents’ medical expenses may be used for meeting the deductible of more than one child at a time. Medical expenses of siblings may not be used for a child's deductible.

17.3.1 Deductible Period

The child under 19 can choose to begin the BadgerCare Plus deductible period as early as three months prior to the month of application and as late as the month following the month of 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..

Example 1

On November 1, John’s mother and stepfather apply for BadgerCare Plus for themselves, John, and John’s two stepbrothers. The family’s countable income is 225% of the FPL. John’s mother has employer-sponsored insurance that covers her and John. John is ineligible for BadgerCare Plus due to the insurance access. John’s stepbrothers are eligible for BadgerCare Plus with a premium. Because the health insurance does not cover all of John’s medical expenses, in December, John’s mother requests a deductible for John. The deductible period is December through May. John has medical bills that will meet the deductible as of January 1. John will be covered under BadgerCare Plus with no premium from January through May.

The BadgerCare Plus deductible period for a child can include a month in which they would have been ineligible for a non-financial reason other than health insurance access or coverage, with one exception. A deductible period may not begin with a month in which the child is non-financially ineligible for a reason other than health insurance access or coverage. Although excess income is still calculated over a six-month period, the child may only be certified for BadgerCare Plus during the dates when they met all non-financial criteria other than health insurance access or coverage.

A new deductible period can be established at any time before the current deductible has been met. A new application for the child must be signed and submitted in order for the new deductible period to be established. A new application is required regardless of when the previous deductible period was established or if anyone in the household is eligible for another health care program.

Example 2

Jose applied for BadgerCare Plus for his 14-year-old child, Ellie, on April 1. Ellie is eligible for a deductible period from April 1 through September 30. She has not incurred enough expenses to meet the deductible. In July, the household’s income decreased, and they would like to have a new deductible period for Ellie from July 1 through December 31. Jose must submit a new, signed application for Ellie for the IM agency to establish a new deductible period.

17.3.2 Calculating the Deductible Amount

To calculate the dollar amount of the BadgerCare Plus deductible for a child:

Determine the BadgerCare Plus deductible period.
Find the child’s assistance group's total countable income for each month in the deductible period.
If the assistance group’s total countable income includes the income of someone other than the child, the child’s parents, or, if married, the child’s spouse, subtract the income of that person, but do not change the group size of the AG.
Compare the total income of each month with 150% of the FPL. If a month's income is less than or equal to 150% of the FPL, ignore it. If a month's income is more than the income limit (150% of the FPL), find the excess income by subtracting the income limit from the income of that month. The child could choose to drop the deductible for months their income decreases so that the child is eligible to enroll in BadgerCare Plus.
Add together the excess income of the months in the deductible period. The result is the child’s BadgerCare Plus deductible amount.

Example 1

Kyle is 14 years old, and his assistance group's income is over 156% of the FPL. Because of his age and assistance group's income amount, he is subject to health insurance access policies. He is ineligible for BadgerCare Plus because he is covered under his mother’s employer-sponsored health insurance plan. The household’s size is five. Their income is $366.25 over the 150% FPL for a group size of five. Kyle’s six-month deductible amount is $2,197.50. (366.25*6=$2,197.50).

Example 2

Mark, who is five years old, is ineligible for BadgerCare Plus because his assistance group's income is over 306% of the FPL. The household is made up of Mark’s mother and 17-year-old brother whose income is counted because he is expected to be required to file taxes. Mark’s assistance group’s income is $3,026 over the 150% FPL for a group size of three. However, because Mark’s brother is not his parent or spouse, his income must be excluded from the deductible calculation. This reduces the excess income to $1,526. John’s six-month deductible amount is $9,156 ($1,526*6=$9,126).

This page last updated in Release Number: 22-03
Release Date: 12/05/2022
Effective Date: 12/05/2022