State of Wisconsin Department of Health Services

Release 24-02 August 22, 2024

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41.2 Eligibility Requirements

Pregnant members (or when applicable, their assistance group), must meet the following BadgerCare Plus eligibility requirements to qualify for the BadgerCare Plus Prenatal Program:

1. The applicant’s net countable income must not exceed 306% of the FPL.
2. The applicantA request for BadgerCare Plus coverage. The request must be on the Department's or Federally-facilitated Marketplace’s application, registration form or account transfer (from Federally-facilitated Marketplace) and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. must not have current or past access to an employer’s health insurance benefit where the employer pays 80% or more of the premium cost or to any State of Wisconsin health insurance plan.
3. The applicant must provide any required verifications. Note: Pregnancy will only be verified if the worker has information that contradicts the applicant’s self-declared information (see Section 9.9.3 Pregnancy). 
4. The applicant must not have health insurance coverage (see Chapter 7 Health Insurance Access and Coverage Requirements) through any HIPAA standard plan now or in the three calendar months prior to the BadgerCare Plus Prenatal request.

41.2.1 Unique Aspects of BadgerCare Plus Prenatal Program

1. Providing an SSNSocial Security number is not an eligibility requirement for either inmates or non-qualifying immigrants applying for the BadgerCare Plus Prenatal Program.
2. Cooperation with Child Support Enforcement is not an eligibility requirement for this program.
3. Unlike regular BadgerCare Plus which locks in eligibility throughout the pregnancy, BadgerCare Plus Prenatal Program eligibility may be terminated with timely notice for failure to meet any of the BadgerCare Plus eligibility requirements (see Section 41.1 BadgerCare Plus Prenatal Program).
4. There is no Presumptive Eligibility for the BadgerCare Plus Prenatal Program. Eligibility for the BadgerCare Plus Prenatal Program may only be determined by the IM agencies.
5. There is no three-month backdating option available for Prenatal Program members.
6. Unlike BadgerCare Plus for Pregnant Members, Prenatal Program members are not eligible for the 60-day pregnancy extension but are eligible for Emergency Services during that time.

41.2.2 BadgerCare Plus Prenatal Program and Public Charge

 BadgerCare Plus Prenatal Program is not considered in public charge determinations (see Section 4.3.4 Public Charge).

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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