State of Wisconsin Department of Health Services

Release 26-02 April 15, 2026

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25.8 Begin Dates

25.8.1 Begin Dates Introduction

BadgerCare Plus eligibility begins the first day of the month in which the valid 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. is submitted and all eligibility requirements are met, with the following exceptions. For these exceptions, begin dates are the date a valid application is submitted, all program requirements are met, and:

1. Deductible - The amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan.The date the deductible was met.
2. Newborn - The date the child was born.   
3. Foster Care Medicare - The date the person entered into foster care. These dates are established by child welfare agencies. 
4. Inmates - The restriction on covered services will end the date the member is no longer an inmate of a public institution. See Section 45.4 Suspension End Date.

25.8.2 Backdated Eligibility

Most types of BadgerCare Plus eligibility can be backdated up to three months prior to the month of application. 

A backdate request can be made at any time except when the member is already enrolled and backdating the member’s eligibility would result in a deductible for the backdated period.

All pregnant persons, except those eligible under the BadgerCare Plus Prenatal program, may have their eligibility backdated to the first of the month, up to three calendar months prior to the month of application. See Section 25.8.2.5 Pregnant Members for more information.

All former foster care youth that meet the criteria in Section 11.2 Former foster care youth may have their eligibility backdated to the first of the month, up to three calendar months prior to the month of application.

Children determined eligible for BadgerCare Plus are eligible for the following periods of backdated eligibility:

• Infants less than one-year old may have their eligibility backdated up to the first of the month, three calendar months prior to the month of application for any of the months in which their family income was at or below 306% FPL,
• Children ages one through five may have their eligibility backdated up to the first of the month, three calendar months prior to the month of application for any of the months in which their family income was at or below 191% FPL, and
• Children ages six through 18 may have their eligibility backdated up to the first of the month, three calendar months prior to the month of application for any of the months in which their family income was at or below 156% FPL.

All non-pregnant, non-disabled parents and caretakers may have their eligibility backdated up to the first of the month, three calendar months prior to the month of application for any of the months in which their family income was at or below 100% FPL.

Childless adults with assistance group income under 100% FPL are eligible for backdating.

See Section 16.4.3.4.4 Backdated Months for information on counting self-employment income for backdated months.

Note

Applicants are not eligible for backdated health care benefits while pending for citizenship and/or identity. Applicants who are otherwise eligible must be certified for health care benefits for the 95-day good-faith period within the normal application processing timeframe. Once verification is provided, the applicant’s eligibility must then be determined for backdated health care benefits if they have been requested. See Section 4.2 Verifying U.S. Citizenship for more information.

25.8.2.1 Backdated Eligibility Timeframe

The backdated eligibility cannot go back further than the first of the month, three months prior to the application month. The member may be certified for any backdate month in which they would have been eligible had they applied in that month. 

In the case of children, certify the person for any backdate month in which they would have been eligible had they applied in that month and in which their assistance group income was at or below the appropriate FPL level for their age group.

25.8.2.2 Determining Backdated Eligibility

Actual nonfinancial information (for example, household composition) and actual income is used to determine eligibility in the backdated months.

Actual income is used to determine backdated eligibility under gap filling rules for months in a past calendar year. When determining backdated eligibility under gap filling rules for months in the current calendar year, expected annual income is assessed using the same process for non-backdated months.

The reasonable compatibility test is used when determining backdated eligibility (see Section 9.12 Reasonable Compatibility for Health Care). If the reasonable compatibility test is passed, further verification of income may not be requested or required. If the reasonable compatibility test is not passed, further verification of income is required.

See Section 16.4.3.4.4 Backdated Months for information on counting self-employment income for backdated months. 

25.8.2.3 Medical Bills During Backdated Eligibility Period

If a member has incurred a bill from a BadgerCare Plus certified provider during a backdate period, the member should contact the provider to inform them to bill BadgerCare Plus. The member may be eligible to receive a refund, up to the amount the member already paid to the provider.

Example 1

Mary, who is pregnant with an August due date, applied for BadgerCare Plus on April 6, and was found eligible. At the time of application, Mary did not request a backdate.   In September, Mary is billed for a doctor’s appointment she had at the end of February.  Mary can ask to have her eligibility backdated through February. She meets all nonfinancial and financial eligibility criteria in the months of February and March. She is enrolled in BadgerCare Plus for both months.

Example 2

Crystal applied for and was determined eligible for BadgerCare Plus effective February 1. She contacts her IM agency in April to see if she is eligible for coverage back to December 1 of the previous year. Crystal had previously reported no income for the month of January. The worker finds no information contrary to what Crystal reported. She is determined eligible for backdated benefits for the month of January. However, Crystal reported that she received unemployment benefits in the previous year and had a seasonal job from November 1 through December 31. Her last paycheck was received on December 31. Crystal reports she earned $5,000 from the two-month seasonal job. Based on her monthly income ($2,500), she is not eligible for BadgerCare Plus in December. Crystal’s annual income is reviewed for the previous year to see if she may be eligible based on annual income gap filling rules. A SWICA match shows that she earned a total of $5,000 during the fourth quarter of the previous year. The unemployment compensation query shows that Crystal received a total of $3,200 in unemployment benefits during the previous year. Her annual income for the previous year is $7,200 ($5,000 from wages earned and $3,200 from unemployment benefits). Her annual income for the previous year is below 100% of the FPL. Crystal is eligible for backdated benefits under gap filling rules for the month of December.

25.8.2.4 Family Planning Only Services

Eligibility for FPOSFamily Planning Only Services - This plan provides certain services and supplies to people who are of childbearing or reproductive age to prevent unplanned pregnancies. begins on the first of the month of application if all nonfinancial (see Section 40.4 Nonfinancial Requirements) and financial (see Section 40.5 Financial Requirements) eligibility requirements are met. FPOS may be backdated up to three months prior to the month of application.

25.8.2.5 Pregnant Members

Except for those members eligible only under the BadgerCare Plus Prenatal Program, backdate a pregnant member to whichever is more recent:

1. The first of the month in which the pregnancy began.
2. The first of the month, three months prior to the month of application.

The member can only be eligible for backdated eligibility as a pregnant person for the months in which they were pregnant. If the member is not pregnant at the time of application, but was pregnant during the backdate eligibility period, the member could be eligible as a pregnant member during the backdated months. 

Before backdating BadgerCare Plus, verify that the member has met all the eligibility requirements during the backdated period.

See Section 41.5 BadgerCare Plus Prenatal Program Eligibility Begin Date for BadgerCare Plus Prenatal Program eligibility begin date policy.

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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