State of Wisconsin Department of Health Services

Release 24-01 April 03, 2024

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1.1 Introduction to BadgerCare Plus

1.1.1 Overview

BadgerCare Plus is a state and federal program that provides health coverage for low-income Wisconsin residents. To be eligible for BadgerCare Plus, a person must meet certain non-financial and financial requirements.

Depending on their age, income, and other criteria, BadgerCare Plus members have their benefits funded by either the Medicaid program or Children's Health Insurance Program (CHIP).

Note	BadgerCare Plus replaced Aid to Families with Dependent Children-Medicaid (AFDC-Medicaid), Healthy Start, and BadgerCare.

1.1.2 BadgerCare Plus Coverage Groups

Populations eligible for BadgerCare Plus include:

• Children younger than 19 years old
• Pregnant persons
• Parents and caretakers of children younger than 18 years old and dependent 18-year-olds
• Parents and caretaker relatives whose children have been removed from the home and placed in out-of-home care
• Former Foster Care Youth younger than 26 years old who were in out-of-home care when they turned 18
• Adults ages 19–64 who are not receiving Medicare, except Medicare Part B Immunosuppressive Drug Benefit (Part B-ID), and do not have dependent children

For information on income limits, see Section 16.1 Income and Section 50.1 Federal Poverty Level Table.

All BadgerCare Plus members receive coverage under the Standard Plan. See Chapter 38 Covered Services for information on covered services.

BadgerCare Plus is funded by Medicaid and CHIP. CHIP, which is also known as State Children's Health Insurance Program (SCHIP) or Title 21, is primarily a program covering low-income children’s health care needs. In Wisconsin, these low-income children include children with incomes above the Medicaid income limits up to 306% of the Federal Poverty Level (FPL). Children eligible for CHIP are covered under BadgerCare Plus. CHIP also covers pregnant persons who are enrolled in the BadgerCare Plus Prenatal Program.

Note

Receipt of Medicare Part B-ID has no effect on an individual's eligibility for BadgerCare Plus. This is a limited benefit that covers only immunosuppressive drugs. It is only available to beneficiaries who don't have comprehensive health coverage which pays for their immunosuppressive drugs, so if a member is enrolled in BadgerCare Plus, it is up to the member to disenroll from Medicare Part B-ID by contacting the Social Security Administration (SSA).

1.1.3 Limited Coverage Health Care Plans

BadgerCare Plus also has several limited coverage health care plans. These include:

• Family Planning Only Services. People of childbearing or reproductive age may be eligible for limited benefits under the Family Planning Only Services Program.
• BadgerCare Plus Prenatal Program. Documented and undocumented immigrants who are pregnant and ineligible for BadgerCare Plus solely due to their immigration status may be eligible for the BadgerCare Plus Prenatal Program.
• BadgerCare Plus Emergency Services. Documented and undocumented immigrants who are children, pregnant women, parents, or caretakers and who are ineligible for BadgerCare Plus solely due to their immigration status may be eligible for coverage for BadgerCare Plus Emergency Services.
• Tuberculosis (TB)-Related Medicaid. People infected with TB who are not eligible for any other category of full-benefit BadgerCare Plus or Medicaid may be eligible for limited benefits for the treatment of TB.

1.1.4 Wisconsin Medicaid

Medicaid is a state and federal program that provides health coverage for Wisconsin residents who are elderly, blind, or disabled. In addition to this, Medicaid funds the benefits of most adults and children enrolled in BadgerCare Plus.

Medicaid is also known as Medical Assistance, MA, and Title 19.

1.1.4.1 Medicaid Programs

The following are different subprograms of Medicaid:

• Home and Community Based Waivers Long-Term Care and IRISInclude, Respect, I Self-Direct
• Institutional Long-Term Care Medicaid
• Katie Beckett
• Managed long-term care programs (Family Care, Family Care Partnership, Program of All-Inclusive Care for the Elderly (PACE))
• Medicaid Purchase Plan (MAPP)
• Supplemental Security Income (SSI) Medicaid
• SSI-related Medicaid
• Wisconsin Well Woman Medicaid
• Emergency Services for Non-Qualifying Immigrants (limited benefit)
• Medicare Savings Programs (limited benefit):
  • Qualified Medicare Beneficiary (QMB)
  • Specified Low-Income Medicare Beneficiary (SLMB)
  • Specified Low-Income Medicare Beneficiary Plus (SLMB+)
  • Qualified Disabled and Working Individual (QDWI)
• SeniorCare (limited benefit)

1.1.5 Health Care Choice

It is possible for individuals to qualify for both BadgerCare Plus and Elderly, Blind, or Disabled (EBD) Medicaid based on financial and non-financial eligibility criteria (see Chapter 49 Health Care Choice).  

1.1.6 Ways to Apply

A person can apply for BadgerCare Plus:

• Online using ACCESS
• By phone by calling the income maintenance (IM) consortium or tribal agency
• In-person at the IMincome maintenance consortium or tribal agency
• By mail using a paper application

A person can also apply through the Federally-Facilitated Marketplace (FFM).

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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