7.1 Health Insurance Conditions of Eligibility

To prevent the crowd out of private insurance, BadgerCare Plus benefits may be denied or terminated for groups who have certain current health insurance coverage.

The following groups are subject to current health insurance coverage policies:

Children ages one through five with household incomes over 191% of the FPL

Children ages six through 18 with household incomes over 156% of the FPL

Note	If a child qualifies for continuous coverage, their benefits cannot be terminated during the 12-month continuous coverage period because of health insurance coverage. Their benefits can only be denied or terminated during application or renewal.

Pregnant persons eligible under the BadgerCare Plus Prenatal Program at any income level

The following groups are exempt from the policies related to current health insurance coverage:

Infants younger than one year old
Children younger than 19 years old who are in a continuous coverage period
Children younger than 19 years old who have met a deductible (exempt only during the deductible period)
Children who are in an extension
Children ages one through five with household income at or below 191% of the FPL
Children ages six to 18 with household income at or below 156% of the FPL
Former Foster Care Youth
Pregnant persons and pregnant minors, other than those in the BadgerCare Plus Prenatal Program
All adults 19 years old or older

Childless adults are not eligible for BadgerCare Plus if they are enrolled in any part of Medicare except Medicare Part B Immunosuppressive Drug Benefit (Part B-ID).

This page last updated in Release Number: 25-02
Release Date: 04/09/2025
Effective Date: 02/22/2025

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