17.1 Deductibles

Through March 31, 2014 children (under age 19) with income above 150% of the FPL who have access to insurance can qualify for BadgerCare Plus by meeting a deductible.

Effective April 1, 2014, children (under age 19) with income over 300% FPL (non-MAGIApply to households whose eligibility is determined using BadgerCare Plus relationship rules (prior to March 31, 2014) to budget income for a household prior to transitioning to MAGI BadgerCare Plus budgeting rules. rules) or 306% (MAGIModified Adjusted Gross Income. MAGI rules are used to determine BadgerCare Plus eligibility for new applicants beginning in 2014 and for existing members as of March 31, 2014, or their next regularly scheduled renewal, whichever is later. MAGI rules are based on tax relationships and family relationships, and they consider taxable income and whether children and tax dependents are required to file. rules) may become eligible for BadgerCare Plus by meeting a deductible. Children with income over 150% FPL (non-MAGIApply to households whose eligibility is determined using BadgerCare Plus relationship rules (prior to March 31, 2014) to budget income for a household prior to transitioning to MAGI BadgerCare Plus budgeting rules. rules) or 156% FPL (MAGIModified Adjusted Gross Income. MAGI rules are used to determine BadgerCare Plus eligibility for new applicants beginning in 2014 and for existing members as of March 31, 2014, or their next regularly scheduled renewal, whichever is later. MAGI rules are based on tax relationships and family relationships, and they consider taxable income and whether children and tax dependents are required to file. rules) who are denied BadgerCare Plus solely due to access to health insurance may also become eligible for BadgerCare Plus by meeting a deductible. The deductible amount is calculated for a six-month period using the amount of income that exceeds 150% FPL.

Pregnant women with incomes above 300% FPL (under non-MAGI rules) or 306% FPL (under MAGI rules) can qualify for BadgerCare Plus by meeting a deductible. The deductible amount is calculated for a six month period using the amount of income that exceeds 300% FPL for pregnant women. The deductible is met by incurring medical expenses that equal the deductible amount.

Note: When determining the deductible amount under MAGI rules, only the income of the member, the member’s spouse, and if the member is under age 19, the member’s parents should be considered. If a sibling’s or tax dependent’s income has been counted as part of the applicant’s regular MAGI assistance group, it should be excluded for purposes of calculating the deductible. Do not change the group size for the MAGI assistance group.

This page last updated in Release Number: 14-01

Release Date: 02/07/14

Effective Date: 02/01/14