25.8 Begin Dates

25.8.1 Backdated Eligibility
1. 25.8.1.1 BadgerCare Plus Family Planning Services
2. 25.8.1.2 Pregnant Women

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:

DeductibleThe 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.
Newborn—The date the child was born.
Person adds—The date the person moved into the household.
Recent moves—The date the member moved to Wisconsin.
Insurance coverage ends—The begin date for BadgerCare Plus is the date following the coverage end date.

25.8.1 Backdated Eligibility

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.

All former foster care youth that meet the criteria in Chapter 11 Foster Care Medicaid 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.

When backdating BadgerCare Plus, do not go back further than the first of the month, three months prior to the application month. Certify the person 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.

When determining backdated eligibility, use actual nonfinancial information (for example, household composition) and actual income in the backdated months. When determining backdated eligibility under gap filling rules for months in a past calendar year, use actual income. When determining backdated eligibility under gap filling rules for months in the current calendar year, assess expected annual income 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.

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

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 Documenting Citizenship and Identity for more information.

If a member has incurred a bill from a BadgerCare Plus certified provider during a backdate period, instruct the member to contact the provider to inform them to bill BadgerCare Plus. The member may be eligible to receive a refund, up to the amount 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. Her worker certifies her for BadgerCare Plus for both months.

Example 2

Crystal applied for and was determined eligible for BadgerCare Plus effective February 1, 2018. She contacts her IM agency in April 2018 to see if she is eligible for coverage back to December 1, 2017. Crystal had previously reported no income for the month of January 2018. The worker finds no information contrary to what Crystal reported. She is determined eligible for backdated benefits for the month of January 2018.

However, Crystal reported that she received unemployment benefits in 2017 and had a seasonal job from November 1, 2017, through December 31, 2017, with her last paycheck received on December 31, 2017. Crystal reports she earned $2,000 from the seasonal job and received a lump sum payment of $500 for December. Based on her monthly income ($2,500), she is not eligible for BadgerCare Plus for December 2017.

The worker checks Crystal’s annual income for 2017 to see if she may be eligible based on annual income. A SWICA match shows that she earned a total of $3,995 during the fourth quarter of 2017. The unemployment compensation query shows that Crystal received a total of $3,200 in unemployment benefits during 2017. Her annual income for 2017 is $7,695 ($3,995 from wages earned, $3,200 from unemployment benefits, and a $500 lump sum payment). Her annual income for 2017 is below 100% of the FPL. Crystal is eligible for backdated benefits under gap filling rules for the month of December 2017.

25.8.1.1 BadgerCare Plus Family Planning 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.

25.8.1.2 Pregnant Women

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

The first of the month in which the pregnancy began.
The first of the month, three months prior to the month of application. If a woman was pregnant before the date of her application, backdate her BadgerCare Plus even though she is not pregnant on the date of application. Do not, however, continue her eligibility as a pregnant woman beyond the end of the pregnancy. Before backdating her BadgerCare Plus, verify that she 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.

This page last updated in Release Number: 23-03
Release Date: 08/14/2023
Effective Date: 08/14/2023