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State of Wisconsin |
Release 24-01 |
On December 29, 2022, the Consolidated Appropriations Act, 2023, was signed into law. This legislation requires that children in certain Medicaid programs and the Children’s Health Insurance Program (CHIP) are provided with 12 months of continuous health care coverage, with some limited exceptions, effective January 1, 2024. Continuous coverage means that the child will not lose coverage during that time, even if the family’s situation changes.
Effective January 1, 2024, most children under age 19 enrolled in BadgerCare Plus and Medicaid programs will have 12 months of continuous coverage, starting with the date of their health care application, new certification period at renewal, or when the child otherwise becomes eligible under a qualifying group. This also applies when a new child under 19 is added to a case that already has a child with 12 months of continuous coverage.
| Example 1 | James applies for health care for his 13-year-old son Henry on January 17, 2024, with a three month backdate, and Henry is determined eligible as of October 1, 2023. Henry will have continuous coverage from January 1 through December 31, 2024. Even if the household has a change in circumstances during the certification period, Henry will remain eligible through December 31, 2024. |
| Note | Backdated months do not count toward the 12-month continuous coverage period. To qualify for a 12-month continuous coverage period, a child must be eligible for the application month and/or a following month. If a child is only eligible in a backdated month, they do not qualify for a 12-month continuous coverage period. |
Children who are already members of an applicable health care program on January 1, 2024, will have a continuous coverage period that extends to their next renewal date.
| Example 2 | Jill is 10 years old. She was enrolled in Medicaid in May 2023. She is still enrolled as of January 1, 2024, so she will have continuous coverage from January 1, 2024, to her renewal date of April 30, 2024. Even if the household reports a change and she goes above the program income limit, she will remain eligible through April 30, 2024. |
At renewal, a child must meet the program’s eligibility requirements in order to get a new 12-month period of continuous coverage.
| Example 3 | Gino is 16 and has been enrolled in Medicaid since May 2020. Gino’s renewal is due in March 2024. Because Gino is enrolled as of January 1, 2024, he also has continuous coverage until his renewal in March 2024. At renewal, Gino no longer meets program rules, so his health care benefits end March 31, 2024. He does not qualify for a new 12-month continuous coverage period. |
Children under age 19 in the following programs are eligible for 12 months of continuous coverage:
Continuous coverage does not apply to children:
Qualifying children under 19 will only lose health care coverage during their 12-month period for the following reasons:
| Example 4 | Carlos is 17 and enrolls in Medicaid on February 1, 2024. On May 12, the household reports moving to Florida. Carlos’ Medicaid ends May 31, 2024. |
| Example 5 | Carolina applies for Medicaid for her son Javier. Javier is eligible, but verification of his citizenship is still needed. Javier is enrolled in Medicaid as of February 1, 2024, and is given a reasonable opportunity period to verify his citizenship. Javier’s citizenship is not verified by the due date of May 10, 2024, so his Medicaid ends May 31, 2024. |
If a child becomes incarcerated and their eligibility is suspended, their continuous coverage will run in the background. If they are released from incarceration within the 12-month period, they will qualify for continuous coverage for the rest of the 12-month period.
If a child’s only parent or caretaker becomes incarcerated, the child will keep their health care for the rest of the 12-month period. If the child becomes eligible on another case or if they are enrolled in Foster Care Medicaid, they will get a new 12-month period of continuous coverage (see BadgerCare Plus Handbook, SECTION 1.2.8 FOSTER CARE MEDICAID).
An immigrant child enrolled in Emergency Services qualifies for a 12-month period of continuous coverage. Their enrollment is not limited to the period their provider indicates they require treatment of an emergency medical condition.
If a child enrolled in Institutional Medicaid is discharged from a medical institution or institution for mental diseases (IMD), and they are not eligible for another category of health care, they will keep their Institutional Medicaid for the rest of the 12-month period.
If a child enrolled in HCBW Medicaid is disenrolled from their waiver services or managed care organization (for example, due to loss of functional eligibility or non-payment of cost share), and they are not eligible for another category of full-benefit health care, they will keep their HCBW Medicaid and can keep getting Medicaid card services for the rest of the 12-month continuous coverage period.
| Example 6 | Chen is enrolled in CLTS as of January 1, 2024. His renewal date is September 30, 2024. In April 2024, the county waiver agency reports that Chen is no longer functionally eligible for CLTS. Chen does not qualify for BadgerCare Plus or Medicaid, so he remains enrolled in HCBW Medicaid through September 30, 2024. |
| Note | If someone voluntarily disenrolls from HCBW services, it will be treated as a voluntary disenrollment from HCBW Medicaid and continuous coverage under HCBW Medicaid will end. |
If a child getting SSI Medicaid loses their SSI cash benefits or 1619(b) eligibility, they will keep their SSI Medicaid for the rest of the 12-month continuous coverage period. Their 12-month period is based on the month their most recent enrollment in SSI Medicaid began, since SSI Medicaid does not have applications or renewals.
| Example 7 | Jill is enrolled in SSI Medicaid as of February 1, 2024. Her 12-month continuous coverage period is February 1, 2024, to January 31, 2025. Jill no longer qualifies for SSI cash benefits in September 2024. She will keep her SSI Medicaid through January 31, 2025. |
| Example 8 | Abdul has been enrolled in SSI Medicaid since May 1, 2021. In July 2024, Abdul loses his SSI cash benefits. He will keep his SSI Medicaid through April 30, 2025. |
| Example 9 | Leo was enrolled in SSI Medicaid since January 1, 2021. In August 2024, Leo loses his SSI cash benefits. He will keep his SSI Medicaid through December 31, 2024. In May 2025, Leo starts getting SSI cash benefits again and he is re-enrolled in SSI Medicaid. He gets a new 12-month continuous coverage period from May 1, 2025, to April 30, 2026. |
If a child enrolled in WWWMA no longer requires treatment or gets health insurance that covers their treatment, they will keep their WWWMA for the rest of the 12-month continuous coverage period.
During the 12-month continuous coverage period, a child may not move from a Medicaid-funded category of health care to a CHIP-funded category of BadgerCare Plus (see BadgerCare Plus Handbook SECTION 51.1 BADGERCARE PLUS CATEGORIES). However, a child may move from a CHIP-funded category of BadgerCare Plus to a full-benefit Medicaid program. One exception to this is that a child may not move from a CHIP-funded category of BadgerCare Plus into an earned income or spousal support extension.
This page last updated in Release Number: 23-04
Release Date: 12/18/2023
Effective Date: 01/01/2024
The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 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-10030