18.1 Extensions

18.1.1 Introduction
18.1.2 Pregnant Women
18.1.3 Children

18.1.1 Introduction

A BadgerCare Plus extension is a period of eligibility given to a person when the assistance group's (AGs) monthly income increases above 100% FPL either due to an increase in earned income, spousal support, or both, and otherwise meets the BadgerCare Plus eligibility criteria for people with monthly incomes below 100% FPL.

A parent/caretaker relative or pregnant person can enter an extension due to a monthly income increase above 100% FPL in the AG’s earned income, spousal support, or both. The children, stepchildren, and non-legally responsible relative (NLRR) children of the parent/caretaker may also enter the extension at this time, provided they are under age 19, living with the parent/caretakers, and meet the income requirements (see Section 18.1.3 Children). If the child is in their 12-month continuous coverage period, the child will stay in their current BadgerCare Plus assistance group while their parent(s) enter the extension. The child’s BadgerCare Plus and the parent’s extension renewal dates will align.

BadgerCare Plus members eligible as childless adults are not eligible for an extension. BadgerCare Plus members eligible based on annual income, known as gap filling, are not eligible for an extension.

If a family is moving out of the State of Wisconsin at the time of the income increase, they would not be eligible for the extension.

In late renewal situations, the renewal must have been submitted in the month the renewal is due in order for the family to be eligible for the extension.

If all members of the household are eligible for an extension, verification of income is not required. If a member of the household is eligible for BadgerCare Plus but not in an extension, the household may be required to provide verification of income for determining that person’s BadgerCare Plus eligibility. If verification is not provided timely, it will not impact the other members’ eligibility in a BadgerCare Plus extension.

Example 1

The Brown family’s health care renewal is due July 31. The renewal is submitted to the agency on July 31. The agency processes the renewal on August 7. The agency determines that the Brown family’s monthly income is now over 100% of the FPL and no financial verification is required since all members of the family meet the criteria to be eligible under a BadgerCare Plus extension. The Brown family enters into an extension starting August 1.

Example 2

The Williams family’s health care renewal is due July 31. The renewal is submitted on August 9. They are not eligible for an extension.

Example 3

Janine and her son, Zachary, are open for BadgerCare Plus under an extension, and her daughter, Amy, is open for regular BadgerCare Plus (not an extension). Janine reports an increase in income. She will be required to verify her new income since her income is counted when determining Amy’s BadgerCare Plus eligibility.

While on the extension, children are not subject to the health insurance access and coverage requirements. See Section 7.1 Health Insurance Conditions of Eligibility for the full list of people exempt from the policies related to health insurance access and coverage requirements.

18.1.2 Pregnant Women

A pregnant woman is able to enter an extension if she was eligible for BadgerCare Plus as a pregnant woman or a parent or caretaker relative at any time during the pregnancy with income at or below 100% of the FPL in three of the past six months. In most cases, her continuous eligibility as a pregnant woman will take precedence over the extension, but the extension will be maintained and will result in eligibility if the pregnancy and postpartum period end prior to the end of the extension. The pregnant woman will remain exempt from the premium requirements through the end of the extension certification period.

18.1.3 Children

If the child is in their 12-month continuous coverage period, the child will stay in their current BadgerCare Plus assistance group while their parent(s) enter the extension. The child’s BadgerCare Plus and the parent’s extension renewal dates will align.

Under most circumstances, the end of an extension will apply to all of the members of the BadgerCare Plus Test group. However, when the household income decreases to 100% FPL or less, the extension will end for the parent(s), but any children would remain in the extension. All dependent children, stepchildren, and NLRRNon-legally Responsible Relative (NLRR) Caretaker is a caretaker who has no legal responsibility for the child under their care. NLRR caretakers and their spouses can be eligible for BC+ as caretakers. children whose parent or caretaker may become eligible for an extension will be eligible for the same extension provided that in the month prior to the start of the extension the child is both eligible for BadgerCare Plus and:

Has AG income under 306% FPL and is under age one.
Has AG income under 191% FPL and is age one through age five.
Has AG income under 156% FPL and is age six through age 18.

Conditions:

Children do not have to be eligible for BadgerCare Plus for three of the past six months.
The child’s AG income does not have to be below 100% FPL at the time the extension starts.
CENs are not eligible for extensions.
A child who is currently in an extension is not eligible for a new extension.
If a parent’s income decreases below 100% FPL, the child’s extension continues.
Once a child is in an extension, the child does not lose the extension for any reason except for death, moving out of Wisconsin, or turning 19 while in an earned income extension.
The child is not in a 12-month continuous coverage period.
The child is not eligible for other full-benefit coverage.

Note	If a child is in an unexpired extension and a parent qualifies for a new extension, the child’s extension will continue to stay in the original extension eligibility category until it expires. The child is not eligible for the new extension.

This page last updated in Release Number: 24-02
Release Date: 08/22/2024
Effective Date: 08/22/2024