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State of Wisconsin |
Release 24-03 |
For a list of medical status codes, see Process Help, Chapter 81 Forward Health iChange.
The following table identifies the copays or premiums for which BadgerCare Plus members may be responsible. The table also provides information on the federal program under which members are eligible, if applicable.
| Description | Income (FPL) | Subject to Copays | Premium | Funding |
| Pregnant woman | 0 - 306% | No | No | T19 |
| Pregnant woman deductible (see Section 17.2.3 Calculating the Deductible Amount) |
>306% | No | No | T19 |
| Pregnant minor under age 19 | 0 - 306% | No | No | T19 |
| Pregnant non-qualifying immigrant | 0 - 306% | No | No | T21 Separate CHIP |
| Pregnant inmate | 0 - 306% | No | No | State-Funded |
| CEN | 0 - 156% | No | No | T19 |
| CEN—Mom on T19 on DOB | >156% | No | No | T19 |
| Child under age 19 | 0 - 100% | No | No | T19 |
| Child under age 6 | >100 - 156% | No | No | T19 |
| Child < age 1 | >156 - 306% | No | No | T19 |
| Child age 1 through 5 | >156 - 191% | No | No | T19 |
| Child age 1 through 5 | >191 - 201% | No | No | T21 Separate CHIP |
| Child age 1 through 5 who is a tribal member | >191% - 201% | No | No | T21 Separate CHIP |
| Child age 6 through 18 | >100 - 133% | No | No | T19 |
| Child age 6 through 18 | >133 - 156% | No | No | T19 |
| Child age 6 through 18 | >156 - 201% | No | No | T21 Separate CHIP |
| Child age 6 through 18 who is a tribal member | >156% - 201% | No | No | T21 Separate CHIP |
| Child age 1 through 18 | >201 - 306% | No | Yes | T21 Separate CHIP |
| Child age 1 through 18 who is a tribal member | >201 - 306% | No | No | T21 Separate CHIP |
| Child, under age 19 deductible (see Section 17.3.2 Calculating the Deductible Amount) |
>150% | No | No | T19 |
| Adult Parent/Caretaker | 0% | No | No | T19 |
| Adult Parent/Caretaker | >0 - 100% | Yes | No | T19 |
| Youth exiting out-of-home care up to age 21 | N/A | No | No | T19 |
| Former Foster Care Youth up to age 26 | N/A | No | No | T19 |
| Childless Adult | 0% | No | No | T19 |
| Childless Adult | >0 - 100% | Yes (if >50% FPL) | No | T19 |
| Childless Adult | 0 - 50% | No | No | T19 |
| Childless Adult | >50 - 100% | Yes | No | T19 |
| Transitional Childless Adult | 0 - 50% | No | No | T19 |
| Transitional Childless Adult | >50 - 100% | Yes | No | T19 |
| Transitional Childless Adult | 0% | No | No | T19 |
| Transitional Childless Adult | >0 - 100% | Yes (if >50% FPL) | No | T19 |
| 12-Month BadgerCare Plus Extension Benefit Adult | >100 - 133% | Yes | No | T19 |
| 12-Month BadgerCare Plus Extension Benefit Adult | >133% | Yes | No | T19 |
| 12-Month BadgerCare Plus Extension Benefit Disabled Adult | >100% | Yes | No | T19 |
| 4-Month BadgerCare Plus Extension Benefit, Adult | >100 - 133% | Yes | No | T19 |
| 4-Month BadgerCare Plus Extension Benefit, Adult | >133% | Yes | No | T19 |
| 4-Month BadgerCare Plus Extension Benefit, Disabled Adult | >100% | Yes | No | T19 |
| 12-Month BadgerCare Plus Extension Benefit, Child Under 19 | >100% | No | No | T19 |
| 4-Month BadgerCare Plus Extension Benefit, Child Under 19 | >100% | No | No | T19 |
| Presumptive eligibility for a child under 1 | 0 - 306% | No | No | T19 |
| Presumptive eligibility for a child age 1 through 5 | 0 - 191% | No | No | T19 |
| Presumptive eligibility for a child age 6 through 18 | 0 - 156% | No | No | T19 |
| Presumptive eligibility for a pregnant woman | 0 - 306% | No | No | T19 |
| Presumptive eligibility for parent/caretaker | 0 - 100% | No | No | T19 |
| Presumptive eligibility for childless adult | 0 - 100% | No | No | T19 |
| Emergency Services for Non-Qualifying Immigrants** | <306% | N/A | No | T19 |
| Family Planning Only Services | <306% | N/A | No | T19 |
**See Section 39.1 Emergency Services Income Limits.
All of the categories listed in the table have BadgerCare Plus Standard Plan coverage, except the following:
This page last updated in Release Number: 24-02
Release Date: 08/22/2024
Effective Date: 08/22/2024
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