17-04 Version of 19.5 Initial Payments

19.5 Initial Payments

Payment of the BadgerCare Plus premium is a non-financial condition of eligibility. Initial premium payments must be made before eligibility is confirmed and the members are enrolled. The first month is free if no one in the BadgerCare Plus group was eligible for BadgerCare Plus or Medicaid in the previous month, and the BadgerCare Plus AGassistance group has not received a free month in the previous 12 months. Consider someone with an unmet deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan. as not being eligible for BadgerCare Plus.

The Income Maintenance agency is responsible for collecting the initial payments and recording the payment in CWWCARES Worker Web. The web-based pages used in the CARES operations.. Acceptable payment types include: check (personal, cashiers, travelers, etc.) or a money order. Check must be issued to BadgerCare Plus.

A BadgerCare Plus Premium Information/Payment form, F-10139, must be sent to the fiscal agent along with the payment. (CARES Mainframe manual standard letter CNSL NCBP009901 can also be used). The BadgerCare Plus CARES case number must be included on the form and on the check. Workers must mail the initial BadgerCare Plus premium payment (check or money order) and completed form to:

BadgerCare Plus

WI Dept of Health Services

P.O. Box 93187

Milwaukee, WI 53293-0187

The eligibility policy and time frame procedures for premium payments are as follows:

Initial eligibility date and confirmation occur in the month of application.

When an application is processed in the same month it was received, and a premium for the initial month of eligibility is not due because they are eligible for a free month, the premium for the second month of eligibility must be paid in advance before a family can be enrolled in BadgerCare Plus.

Example 1: Lisa and her family applied for BadgerCare Plus on January 25. On January 31, the worker determined that the family met eligibility requirements effective January 1. Since the family had not been previously eligible for BadgerCare Plus, a premium for January was not assessed since they were eligible for the free month. However, Lisa had to pay the February premium for her family before their eligibility could be confirmed.

Eligibility begins in the month of application - confirmation occurs in a future month.

When an application is not processed within the 30-day application processing period and the family is eligible for a free month, the family must pay both the second and third months’ premium before enrollment. CARES requires that premiums for both the second and third months be paid before confirmation when eligibility is processed any time in the third month.

Example 2: Cheryl and her family applied for BadgerCare Plus on March 25. No one in her family was eligible for BadgerCare Plus in the previous month. At Cheryl’s request, the IM worker extended the 30-day processing time period by ten days for additional verification. The application for BadgerCare Plus was processed on May 2, but the family was determined eligible effective March 1. A premium is not due for March because it is a free month. However, Cheryl had to pay the premium amount for April and May before BadgerCare Plus eligibility could be confirmed.

Eligibility begins in a future month, but application is processed in the month of application.

When an application is processed within 30 days but eligibility does not begin until a future month, the free month is the first future month of eligibility. The family will receive an invoice for the premium amount through the mail. He or she must pay the premium due for the second month by the tenth of the benefit month to remain eligible for BadgerCare Plus.

Example 3: Arnie and his family applied for BadgerCare Plus on April 12. He and his family were determined to be eligible for BadgerCare Plus beginning May 1. A premium is not assessed for May. A coupon for Arnie’s June premium was mailed on May 20 with payment due by June 10.

This page last updated in Release Number: 17-04

Release Date: 12/13/2017

Effective Date: 12/13/2017