Policy History for  5.7.11 BadgerCare Prenatal Program

Release 07-07

5.7.11 BadgerCare Prenatal Program

5.7.11.1 BC Prenatal Program Eligibility Requirements

5.7.11.1.2  Unique Aspects of BC Prenatal Program

5.7.11.2 BC Prenatal Program Policy for non-qualifying aliens:

5.7.11.3  BC Prenatal Program Policy for inmates:

5.7.11.4 BC Prenatal Program Eligibility Begin Date

5.7.11.5  BC Prenatal Program Eligibility End Date

5.7.11.6  Determining BC Prenatal Program Group and Fiscal Test Group

5.7.11.7 BC Prenatal Program Benefit Information

The BadgerCare Prenatal Program provides coverage under the BadgerCare program for women who:

• meet the eligibility requirements detail in 5.7.11.1 through 5.7.11.7
  
  and
   

• have verified pregnancies
  
  and
   

• are not eligible for MA solely because they are either inmates of a public institution (MEH, 3.1.9) or  Non-qualifying aliens (i.e. individuals who are not a U.S citizen 3.2.1 or a qualifying alien 3.2.2),
   

5.7.11.1 BC Prenatal Program Eligibility Requirements

Pregnant women (or when applicable, their assistance groups), must meet the following BC eligibility requirements to qualify for the BC Prenatal Program:

1. The applicant’s net budgetable income must not exceed 185% of the Federal Poverty Level (FPL).  A recipient’s income must not exceed 200% of the FPL.
    

2. Assistance groups with incomes in excess of 150% of the FPL must pay premiums.
    

3. All employed members of the BC assistance group must cooperate with employer wage and health insurance verifications. (EVF-E and EVF-H)
    

4. The applicant must not have access to an employer’s health insurance benefit.
    

5. The applicant must not have health insurance coverage (5.7.3.4) now or in the three calendar months prior to the BC Prenatal request.
    

6. The applicant must provide verification of pregnancy.
    

7. The applicant and program participant must provide other required verifications.
   
    

5.7.11.1.2  Unique Aspects of BC Prenatal Program
 

1. Unlike regular BC, a pregnant woman qualifying for the BC Prenatal Program is not required to be a caretaker of a child.

2. Providing an SSN is not an eligibility requirement for either inmates or non-qualifying aliens applying for the BC Prenatal Program.  

3. Cooperation with Child Support Enforcement is not an eligibility requirement for this program.
    

4. Unlike Healthy Start which locks in eligibility throughout the pregnancy, BC Prenatal Program eligibility may be terminated with timely notice for these pregnant women for failure to meet any of the BC eligibility requirements listed in 5.7.11.1.
    

5. Babies born to women while they are eligible for the BC Prenatal Program are not eligible for Continuously Eligible Newborn (CEN) coverage.  (See 5.2.5 #2)
    

6. There is no Presumptive Eligibility for the BC Prenatal Program.  Eligibility for the BC Prenatal Program may only be determined by the IM agencies.

5.7.11.2 BC Prenatal Program Policy for non-qualifying aliens:

1. For aliens who are legally present in the United States, verify immigration status through normal SAVE procedures in order to determine eligibility for MA.  If SAVE verifies the pregnant woman is a non-qualifying alien (i.e. ineligible for MA) proceed with determining eligibility for the BC Prenatal Program.
    

2. For aliens who do not have legal immigration status, do not request SAVE verification and continue with the determination of eligibility for the BC Prenatal Program.
    

3. For a non-qualifying alien receiving BC through the BC Prenatal Program, if her immigration status changes during the pregnancy, her eligibility for MA must be redetermined using the new status.  If her new status makes her eligible for MA, she is no longer eligible for the BC Prenatal Program, with one exception.  If she is only eligible for an MA deductible because her income is above 185% of the FPL AND her income is below 200% of the FPL, she remains eligible for the BC Prenatal Program.
   
    

5.7.11.3  BC Prenatal Program Policy for inmates:
 

1. Inmates will always be considered to be residing in the county where the jail or prison facility is located.
    

2. An inmate who is released from jail or prison must have her MA eligibility redetermined based on her new circumstances.  Once released from an institution, she is no longer eligible for the BC Prenatal Program with one exception.  If she is only eligible for an MA deductible because her income is above 185% of the FPL AND her income is below 200% of the FPL, she remains eligible for the BC Prenatal Program.
    

NOTE: CARES will redetermine Medicaid eligibility for a pregnant woman in the BC Prenatal Program who becomes a citizen or a qualifying alien, or who is released from prison or jail.  Most of these women will be found eligible for Healthy Start.  For these pregnant women with children whose FTG income is between 185% and 200% of the FPL, CARES will find the women eligible for regular BC.

For childless women in this income range, however, CARES will determine the women to be eligible for a Healthy Start deductible, these women should remain in the BC Prenatal Program. To continue their BC eligibility, change the living arrangement to <26 Inmate> and rerun eligibility.  Using this code will also prevent the women from receiving the 60 day post-partum EMA coverage.

5.7.11.4 BC Prenatal Program Eligibility Begin Date:

BC Prenatal Program eligibility begins no sooner than the first of the month in which a completed application is received and the pregnancy is verified.

Pregnant non-qualifying aliens who are not found eligible for the BC Prenatal Program should have Emergency Services Medicaid eligibility determined according to policy in MEH 3.2.3.

5.7.11.5  BC Prenatal Program Eligibility End Date

BC Prenatal Program eligibility ends when the pregnancy ends.  (Benefits will continue through the end of the month following timely notice requirements.)
 

Non-qualifying aliens who lose eligibility for the BC Prenatal Program when their pregnancy ends, for any reason other than moving out of state, are eligible for Emergency Services Medicaid (3.2.3) from the time they lose BC Prenatal Program eligibility.

5.7.11.6   Determining BC Prenatal Program Group and Fiscal Test Group
 

1. If a pregnant woman is in a household where her spouse or her children are eligible or applying for BC, she is to be included in the BC Group with the other nonfinancially eligible members of her family.  Include the number of verified fetuses when determining the BC FTG size.  If the number is not verified, always count one fetus.
    

2. Pregnant inmates must always be considered to be living alone.  If the inmate is married while incarcerated, consider her to be separated (ignore the spouse) when determining eligibility.  The pregnant inmate’s FTG size will always include herself and the number of fetuses she is carrying.  

NOTE: Women in the Huber program who are eligible for AFDC MA (MEH 5.4) are not eligible for the BC Prenatal Program.  (Remember, pregnant women, participating in the Huber program can only be found eligible for AFDC-MA not AFDC-related MA or HS).
 

3. Pregnant non-qualifying aliens who have no other born children in the home will have their financial eligibility determined in the same way as pregnant women applying for Healthy Start. The BC FTG size will only include the woman, the fetuses and her spouse.  If the pregnant immigrant is a minor living with her parent(s), the parent(s) will be included in the FTG.  

BC Prenatal Program FTG Examples

5.7.11.7 BC Prenatal Program Benefit Information
 

Women determined eligible for the BC Prenatal Program receive a Forward Card, which can also be used to access emergency services under EMA after BC ends.  

BC Prenatal Program and EMA recipients will not be enrolled in an HMO.  Services will only be provided on a fee-for-service basis.

This page last updated in Release Number: 07-03

Release Date: 04/18/07

Effective Date: 04/18/07