19.1 BadgerCare Plus Premiums for Children

Effective April 1, 2024, children in families with income over 201% of the FPLFederal Poverty Level are charged a premium for BadgerCare Plus unless the child is exempt. However, payment of a premium is not a condition of eligibility for BadgerCare Plus. If the premium is not paid, the child will remain eligible for BadgerCare Plus.

New members with an application filing date on or after April 1, 2024, will be charged premiums.

Example 1

Mary applies for BadgerCare Plus for her son, Jack, on April 4, 2024. The household's income is 215% FPL. The application is processed and confirmed on April 5, 2024. Jack is eligible for BadgerCare Plus as of April 1 and a premium will be charged.

Members enrolled prior to April 1, 2024, will not be charged premiums until after their next scheduled renewal for a new certification period beginning May 1, 2024, or later.

Example 2

Aarav's daughter Divya has been open for BadgerCare Plus since August 2023. The household's income is 220% FPL. Because Divya has continuous coverage through July 2024, a premium cannot be charged until her renewal due in July 2024 is completed. Aarav completes the renewal on July 8, 2024, and Divya is determined eligible with household income above 201% of the FPL. A premium will be charged for Divya beginning with the month of August 2024. A premium statement will be sent to Aarav at the end of July for the August premium.

If an individual applies with a filing date before April 1, 2024, the individual will not be charged premiums during the initial certification period, even if the application is processed on or after April 1, 2024. The individual will be charged premiums after they complete their next scheduled renewal.

Example 3

Fatima applies for health care for her daughters, Amina and Aisha, with a filing date of March 25, 2024. The application is processed and confirmed on April 8, 2024, and Amina and Aisha are eligible for BadgerCare Plus with household income at 230% of the FPL. Because they applied before April 1, 2024, premiums will not be charged during the initial certification period. They are eligible for BadgerCare Plus with no premium from March 1, 2024, through February 28, 2025. If their household income remains above 201% of the FPL after they complete their scheduled renewal, a premium will be charged for them at that time.

If a member has a renewal scheduled after April 2024, but completes an early renewal, premiums cannot be charged at that time because the member is still in their 12-month continuous coverage period. Premiums may be charged at the member's next renewal.

Example 4

Maya's son Nathaniel has been open for BadgerCare Plus since November 2023. The household's income is 250% of the FPL. Because Nathaniel has continuous coverage through October 2024, a premium cannot be charged until after his renewal due in October 2024 is completed. Maya calls the agency to renew Nathaniel's BadgerCare Plus in July 2024. This is during Nathaniel's continuous coverage period, so premiums cannot be charged. Premiums may be charged when the household completes their renewal in July 2025.

If a member was disenrolled from BadgerCare Plus before April 2024 because they did not complete their renewal, and they complete a late renewal on or after April 1, 2024, they will be subject to premiums after completing the late renewal.

Example 5

Choua did not complete the renewal for his son Chue's BadgerCare Plus that was due in February 2024, so Chue's BadgerCare Plus ended February 29, 2024. Choua completes a late renewal, the renewal was processed April 2, 2024, and Chue is determined eligible with household income of 228% of the FPL. A premium will be charged for Chue beginning with the month of May 2024. A premium statement will be sent to Choua at the end of April for the May premium.

Payment of a premium is not a condition of eligibility for BadgerCare Plus. If no payment is made, their eligibility for BadgerCare Plus will not be impacted.

Example 6

Mary is charged a premium for her son, Jack, beginning May 2024. A statement is sent to Mary at the end of April, with a due date of May 10. Mary is not able to pay the premium. Jack remains eligible for BadgerCare Plus. Mary will be sent a premium statement for June at the end of May.

The following children are exempt from being charged a premium for BadgerCare Plus:

Pregnant minors
Former Foster Care Youth (see Chapter 11 Foster Care Medicaid)
Children who have met a BadgerCare Plus deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan., during the remainder of the deductible period
Children in a BadgerCare Plus extension
All children under age one including Continuously Eligible Newborns (see Section 8.2 Continuously Eligible Newborns)
American Indian or Alaskan Native Tribal members, the son or daughter of a tribal member, the grandson or granddaughter of a tribal member, or anyone otherwise eligible to receive Indian Health Services
Children whose BadgerCare Plus is suspended due to being incarcerated in jail or prison

Note	Persons who are members of families receiving BadgerCare Plus benefits, but who are individually certified for Elderly, Blind or Disabled (EBD) Medicaid, Wisconsin Well Woman Medicaid, Family Planning Only Services or Emergency Services, are not charged a BadgerCare Plus premium.

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