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1.1 BC+ Introduction

1.1.1 Organization of the BC+ Handbook

1.1.2 BadgerCare Plus Health Plan

1.1.3 Health Care Choice

1.1.4 How to Apply

 

BadgerCare Plus (BC+) is a state/federal program that provides health coverage for Wisconsin families and individuals living in poverty. BC+ replaced the former AFDC-Medicaid, Healthy Start and BadgerCare programs.

 

Potential BC+ members will include:

 

 

For information on income limits see Chapter 16.1 and Chapter 50.1. A person is eligible for BadgerCare Plus if s/he meets all BC+ non-financial and financial requirements.

 

Documented and undocumented immigrants who are children, parents or caretakers and who are ineligible for BC+ solely due to their immigration status may be eligible for coverage for BC+ Emergency Services.

 

Documented and undocumented immigrants who are pregnant and ineligible for BC+ solely due to their immigration status may be eligible for the BC+ Prenatal Program.

 

Women and men ages 15 years of age or older may be eligible for limited benefits under the BC+ Family Planning Only Services program.

 

Women ages 35-65 diagnosed with cervical or breast cancer may be eligible for Well Woman Medicaid. See the Medicaid Handbook for more information on Well Woman Medicaid.

 

Individuals who are elderly, blind or disabled may be eligible for Medicaid.  Medicaid is a state/federal program that provides health coverage for Wisconsin residents that are elderly, blind, or disabled (EBD).  Medicaid is also known as Medical Assistance, MA, and Title 19.  There are different subprograms of Medicaid:


 

See the Medicaid Handbook for more information about these sub-programs.

1.1.1 Organization of the BC+ Handbook

This handbook outlines eligibility policy for Wisconsin’s BadgerCare Plus program. This version documents multiple policy changes that will affect the BC+ program in 2014 as a result of changes in State law and the federal Affordable Care Act. Accordingly, this handbook contains policy for the BadgerCare Plus program that is currently in effect and policy that will take effect in 2014. Policy that is time-limited or time-dependent will be modified with the appropriate effective date. Policy that is not identified as having an effective or end date is currently in place and will continue to exist in 2014.

 

Beginning in 2014, the BadgerCare Plus program will use a different set of eligibility rules to determine household size and countable income. This version of the handbook addresses two forms of budgeting rules. More information about these budgeting methodologies is found in Chapter 2. The new budgeting rules that will be applied to applicants and members in 2014 will be referred to as Modified Adjusted Gross Income (MAGI) rules. The rules currently in place for BadgerCare Plus will be referred to as “non-MAGI rules."

1.1.2 BadgerCare Plus Health Plan

The Standard Plan is for adults, parents or caretakers with household income at or below 100% of the Federal Poverty Level (FPL) and children and pregnant women with income at or below 300% of the FPL.  (See Table 50.1 for FPL limits)
 

BadgerCare Plus has several limited health plans. These include:

 

 

Standard plan members may be asked to pay a share of the cost of services. The co-pay amount ranges from $.50-$3.00 per service.  

 

Beginning February 1, 2014, all new applicants found eligible for BC+ will be covered under the Standard Plan. Beginning April 1, 2014, all BadgerCare Plus members, regardless of when they applied, will receive coverage under the Standard Plan.

 

 

1.1.3 Health Care Choice

 

It is possible for individuals to qualify for both BadgerCare Plus and Elderly, Blind and Disabled Medicaid (EBD MA) based on financial and non-financial eligibility criteria.

 

When a person is eligible for both BC+ and EBD MA, different rules apply based on whether the BC+ eligibility is determined under non-MAGI or MAGI rules.

 

When eligibility is determined for such an individual under non-MAGI rules, CARES will automatically enroll the individual in the program with the best benefit plan and lowest cost share. The individual has the right to request coverage under the program not chosen by CARES.  See (49.1 Health Plan Choice). The change will be effective in the next possible payment following Adverse Action , unless the member requests the change be effective in the month the request to change the health plan was made.

 

If CARES is unable to make an automatic choice between BC+ and EBD MA, a notice requesting the individual make a choice will be generated. Once the member has made a choice the decision remains in effect until:

 

 

When eligibility is determined for such an individual under MAGI rules, federal law requires that once an individual has been determined eligible for EBD Medicaid, s/he must be enrolled in EBD MA, even if they are also eligible for BC+, unless they have a change in circumstances that results in ineligibility for EBD MA. The only exception to this policy is pregnant women who are eligible for both EBD MA and BC+. In these instances, the pregnant woman will be enrolled in the BadgerCare Plus program.

 

If someone is pending for EBD MA or if they have an unmet deductible for EBD MA, the individual is not considered eligible for EBD Medicaid and can enroll in BadgerCare Plus. Pending for EBD MA includes, but is not limited to, waiting for an official disability determination from DDB. If an individual enrolled in EBD MA is determined ineligible for EBD Medicaid for any reason, including going over the asset limit or failing to pay a MAPP premium, s/he can enroll in BC+ if s/he is still eligible to do so.

1.1.4 How to Apply

The following application options are available for anyone who is applying for BC+:

 

  1. ACCESS online application at  https://access.wisconsin.gov/ .

  2. Face-to-Face Interview at the local county/tribal office.

  3. Paper application

  4. Telephone Interview.

  5. An application submitted to the Federally Facilitated Marketplace .

 

Click here to view the Directory of local county/tribal agencies in Wisconsin or call 1-800-362-3002.

 

 

 

 

 

This page last updated in Release Number: 14-02

Release Date: 05/14/14

Effective Date: 04/01/14