State of Wisconsin Department of Health Services

Release 24-03 November 15, 2024

12.2 Express Enrollment Member Eligibility

12.2.1 Coverage

BadgerCare Plus or Family Planning Only Services coverage through an Express Enrollment application is temporary, so it is important that an application for ongoing BadgerCare Plus or Family Planning Only Services coverage is submitted soon after the Express Enrollment application is completed.

Temporary enrollment begins on the day that the Express Enrollment application is submitted and, in most cases, concludes the last day of the following month.

12.2.1.1 Current Enrollment in Ongoing Benefits

An applicant is not eligible for temporary enrollment if he or she is already receiving ongoing benefits. The following table describes the situations where this applies:

Current Enrollment in Ongoing Health Care or Family Planning Only Services Coverage

Applicant is currently enrolled in:	Applicant is applying for temporary enrollment in BadgerCare Plus:	Applicant is applying for temporary enrollment in Family Planning Only Services:
BadgerCare Plus or other ongoing Medicaid coverage	Deny temporary enrollment	Deny temporary enrollment
Family Planning Only Services	Allow temporary enrollment*	Deny temporary enrollment

*If all other temporary enrollment criteria are met

12.2.1.2 Temporary Enrollment Within the Last 12 Months

An applicant may only be temporarily enrolled once in a 12-month period or once per pregnancy. The following table describes the situations where this applies:

Temporary Enrollment Within the Last 12 Months

Applicant was temporarily enrolled in:	Applicant is applying for temporary enrollment in BadgerCare Plus (non-pregnant woman):	Applicant is applying for temporary enrollment in BadgerCare Plus (pregnant woman):	Applicant is applying for temporary enrollment in Family Planning Only Services:
BadgerCare Plus (non-pregnant woman)	Deny temporary enrollment	Allow temporary enrollment*	Allow temporary enrollment*
BadgerCare Plus (pregnant woman)	Deny temporary enrollment	Allow temporary enrollment* as long as the previous temporary enrollment was not for the same pregnancy	Allow temporary enrollment*
Family Planning Only Services	Allow temporary enrollment*	Allow temporary enrollment*	Deny temporary enrollment
No programs	Allow temporary enrollment*	Allow temporary enrollment*	Allow temporary enrollment*

*If all other temporary enrollment data are met

Beginning on the date the Express Enrollment application is submitted, eligible individuals will be able to receive coverage under BadgerCare Plus or Family Planning Only Services.

12.2.1.3 Early Termination of Temporary Enrollment

If a person applies for ongoing health care or Family Planning Only Services coverage and the IMincome maintenance agency makes an eligibility determination prior to the end date of the temporary enrollment period, the temporary enrollment period must end on the date the IM agency completes processing the application for ongoing coverage, regardless of the result of the eligibility determination. The early termination of temporary enrollment will be applied systematically. The following tables further explain when eligibility for ongoing health care or Family Planning Only Services coverage will end temporary enrollment:

Systematic Early Termination of Temporary Enrollment — Applicant Applied for One Program

Applicant is confirmed in CARES as:	Applicant is currently receiving temporary enrollment benefits for Badger Care Plus:	Applicant is currently receiving temporary enrollment benefits for Family Planning Only Services:
Eligible for BadgerCare Plus or other ongoing Medicaid coverage	End temporary enrollment	End temporary enrollment
Eligible for Family Planning Only Services	No change to temporary enrollment	End temporary enrollment
Not eligible for BadgerCare Plus or other ongoing Medicaid coverage	End temporary enrollment	No change to temporary enrollment
Not eligible for Family Planning Only Services	No change to temporary enrollment	End temporary enrollment

 

Systematic Early Termination of Temporary Enrollment — Applicant Applied for Multiple Programs

 

Applicant is confirmed in CARES as:	Applicant is currently receiving temporary enrollment benefits for Badger Care Plus:	Applicant is currently receiving temporary enrollment benefits for Family Planning Only Services:
Eligible for BadgerCare Plus or other ongoing Medicaid coverage but not for Family Planning Only Services	End temporary enrollment	End temporary enrollment
Eligible for Family Planning Only Services but not for BadgerCare Plus or other ongoing Medicaid coverage	End temporary enrollment	End temporary enrollment
Not eligible for Family Planning Only Services, BadgerCare Plus, or other ongoing Medicaid coverage	End temporary enrollment	End temporary enrollment

12.2.1.4 Automatic Extension of Temporary Enrollment

If the IM agency is unable to finish processing the application for ongoing coverage by the end of the temporary enrollment period, CARES will automatically extend the temporary enrollment period for an additional calendar month. The following tables further explain when temporary enrollment will be extended:

Systematic Extension of Temporary Enrollment — Applicant Applied for One Program

Applicant has applied for one program and eligibility has not been confirmed:	Applicant is currently receiving temporary enrollment benefits for Badger Care Plus:	Applicant is currently receiving temporary enrollment benefits for Family Planning Only Services:
BadgerCare Plus or other ongoing Medicaid coverage	Extend temporary enrollment for BadgerCare Plus	Do not extend temporary enrollment for Family Planning Only Services
Family Planning Only Services	Do not extend temporary enrollment for BadgerCare Plus	Extend temporary enrollment for Family Planning Only Services

Systematic Extension of Temporary Enrollment — Applicant Applied for Multiple Programs

Applicant has applied for multiple programs but eligibility has not been confirmed for all programs:	Applicant is currently receiving temporary enrollment benefits for Badger Care Plus:	Applicant is currently receiving temporary enrollment benefits for Family Planning Only Services:
Eligibility has been confirmed for BadgerCare Plus or other ongoing full-benefit Medicaid coverage but not for Family Planning Only Services	Do not extend temporary enrollment for BadgerCare Plus	Do not extend temporary enrollment for Family Planning Only Services if the applicant is eligible for BadgerCare Plus or other ongoing full-benefit Medicaid coverage Extend temporary enrollment for Family Planning Only Services if the applicant is not eligible for BadgerCare Plus or other ongoing full-benefit Medicaid coverage
Eligibility has been confirmed for Family Planning Only Services but not for BadgerCare Plus or other ongoing full-benefit Medicaid coverage	Extend temporary enrollment for BadgerCare Plus	Do not extend temporary enrollment for Family Planning Only Services

If an application for ongoing coverage is not submitted by the end of the month following the month in which the individual was temporarily enrolled, the temporary enrollment ends the last day of the month following the month in which the individual was enrolled.

12.2.1.5 Temporary Enrollment in BadgerCare Plus for Pregnant Women

Pregnant women temporarily enrolled in BadgerCare Plus through Express Enrollment, are only eligible for ambulatory prenatal services. For coverage of inpatient services, including labor and delivery, they must be enrolled in full BadgerCare Plus. Refer to the Covered and Noncovered Services section of the Express Enrollment in Wisconsin Medicaid or BadgerCare Plus service area of the ForwardHealth Online Handbook for the specific listing of services.

12.2.1.6 Temporary Enrollment in Family Planning Only Services

People who are determined eligible for the Family Planning Only Services benefit will be eligible for family planning and family planning-related services only. Refer to the Covered and Noncovered Services section of Family Planning Only Services service area of the ForwardHealth Online Handbook for the specific listing of services.

12.2.1.7 Temporary Enrollment in BadgerCare Plus for All Other Eligible Populations

All other eligible populations indicated in Section 12.2.2 Eligible Populations will be eligible for BadgerCare Plus coverage. Refer to the Covered and Noncovered Services section of the Express Enrollment in Wisconsin Medicaid or BadgerCare Plus service area of the ForwardHealth Online Handbook for the specific listing of services.

Note:

Women diagnosed with breast or cervical cancer can temporarily enroll in Wisconsin Well Woman Medicaid, which is not part of the online Express Enrollment application tool. A Wisconsin Well Woman Medicaid determination can only be made using form F-10075. See the Medicaid Eligibility Handbook, Section 36.2.2.1, for more information.

12.2.2 Eligible Populations

To be eligible for temporary enrollment in BadgerCare Plus or Family Planning Only Services through the Express Enrollment application process, an applicant must:

• Be a Wisconsin resident (see Section 12.2.2.1)
• Meet the income limit for his or her population type (see Section 12.2.2.2)
• Meet the citizenship and immigration requirement for his or her population type (see Section 12.2.2.3)

Note:

Income limits for BadgerCare Plus eligibility include two ACAAffordable Care Act required adjustments: a five percent disregard and a one percent conversion factor. See the BadgerCare Plus Eligibility Handbook, Section 16.1 Income, for more information.

12.2.2.1 Wisconsin Residency

A person must be a Wisconsin resident to be eligible for temporary enrollment in BadgerCare Plus or Family Planning Only Services. This includes all of the following:

• Being physically present in Wisconsin. There is no minimum requirement for the length of time the person must be physically present in Wisconsin.
• Intending to reside in Wisconsin. This includes people who have entered Wisconsin with a job commitment or who are seeking employment, regardless of whether or not they are employed at the time of applying for temporary enrollment.

12.2.2.2 Income Limits

A person must meet the following income limits to be eligible for temporary enrollment:

• BadgerCare Plus:
  • Pregnant women: Household income is at or below 306 percent of the FPLFederal Poverty Level
  • Children under age 19: Household income is at or below the FPL for the child’s age
    • Younger than age 1: 306 percent of the FPL
    • Ages 1 through 5: 191 percent of the FPL
    • Ages 6 through 18: 156 percent of the FPL
  • Adults (ages 19 through 64), parents, and caretakers: Household income at or below 100 percent of the FPL
• Family Planning Only Services: A person must have income that is at or below 306 percent of the FPL
• Former Foster Care Youth: No income limit.

Individuals who are Former Foster Care Youth have no income limit for temporary enrollment in BadgerCare Plus through Express Enrollment, but must still meet all other non-financial eligibility requirements, including residency and citizenship criteria. A Former Foster Care Youth is an individual age 18 through 25 who was receiving foster care, subsidized guardianship, or court-ordered Kinship Care on the date that he or she turned 18. It does not matter what state he or she was residing in when he or she turned 18. See the BadgerCare Plus Eligibility Handbook, Section 11.2 Former Foster Care Youth, for more information.

• Wisconsin Well Woman Medicaid: Household income is at or below 250 percent of the FPL

Note:

Women diagnosed with breast or cervical cancer can temporarily enroll in Wisconsin Well Woman Medicaid, which is not part of the online Express Enrollment application tool. A Wisconsin Well Woman Medicaid determination can only be made using form F-10075. See the Medicaid Eligibility Handbook, Section 36.2.2.1, for more information.

Refer to the BadgerCare Plus Eligibility Handbook, Section 50.1 Federal Poverty Level Table for more information about income limits.

12.2.2.3 U.S. Citizen or Qualifying Immigrant

A person must meet the following criteria to be eligible for temporary enrollment:

• BadgerCare Plus:
  • Children and pregnant woman: Must be a U.S. citizen or lawfully present in the U.S. There is no requirement for the applicant to have been lawfully present in the U.S. for a certain amount of time.
  • An adult must meet one of the following criteria:
    • Be a U.S. citizen.
    • Be lawfully residing in the U.S. for at least five years.
    • Be lawfully residing in the U.S. and a refugee or be seeking asylum.
    • Be from Cuba or Haiti and lawfully residing in the U.S.
    • Be lawfully residing in the U.S. under a qualified immigration status listed  in 1 through 12 in the BadgerCare Plus Eligibility Handbook, Section 4.3 Immigrants.
• Family Planning Only Services:
  • Applicants under age 19: Must be a U. S. citizen or lawfully present in the U.S. There is no requirement for the applicant to have been lawfully present in the U.S. for a certain amount of time.
  • Applicants age 19 or older must meet one of the following criteria:
    • Be a U.S. citizen.
    • Be lawfully residing in the U.S. for at least five years.
    • Be lawfully residing in the U.S. and a refugee or be seeking asylum.
    • Be from Cuba or Haiti and lawfully residing in the U.S.
    • Be lawfully residing in the U.S. under a qualified immigration status listed  in 1 through 12 in the BadgerCare Plus Eligibility Handbook, Section 4.3 Immigrants.
• Wisconsin Well Woman Medicaid: An applicant must meet one of the following criteria:
  • Be a U.S. citizen.
  • Be lawfully residing in the U.S. for at least five years.
  • Be lawfully residing in the U.S. and a refugee or be seeking asylum.
  • Be from Cuba or Haiti and lawfully residing in the U.S.
  • Be lawfully residing in the U.S. under a qualified immigration status listed  in 1 through 12 in the BadgerCare Plus Eligibility Handbook, Section 4.3 Immigrants.

12.2.3 Inmates of Public Correctional Facilities

Qualified HospitalsQualified hospitals are certified by ForwardHealth to make PE determinations for the following populations: children, pregnant women, individuals applying for FPOS, parents and caretakers, childless adults and women under age 65 with breast or cervical cancer. are allowed to make presumptive eligibility determinations and temporarily enroll patients in BadgerCare Plus who are inmates of certain public correctional institutions (e.g., county jails) as long as those patients are expected to remain in the hospital for more than 24 hours or have at least an overnight hospital admission. The Express Enrollment application process for these patients is the same as for other eligible populations.

Patients who are inmates of a state prison are not eligible for temporary enrollment in BadgerCare Plus or Family Planning Only Services through the Express Enrollment process. See the BadgerCare Plus Eligibility Handbook, Section 3.6 Inmates, for information on the application process for BadgerCare Plus for inmates of state correctional institutions.

This page last updated in Release Number: 17-01
Release Date: 01/25/2017
Effective Date: 01/25/2017

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Notice: The content within this guide is the responsibility of the State of Wisconsin's Department of Health Services (DHS) and the Department of Workforce Development (DWD).

Publication Number: P-16101