State of Wisconsin
Department of Health Services
Release 21-01 March 29, 2021
1.1.2 BadgerCare Plus Coverage Groups
1.1.3 Limited Coverage Health Care Plans
1.1.4 Wisconsin Medicaid
18.104.22.168 Medicaid Programs
1.1.5 Health Care Choice
1.1.6 Ways to Apply
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 CHIP Children's Health Insurance Program.
Note: BadgerCare Plus replaced AFDC Aid to Families with Dependent Children-Medicaid, Healthy Start, and BadgerCare.
Populations eligible for BadgerCare Plus include:
Children younger than 19 years old
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 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 SCHIP State Children’s Health Insurance Program 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 percent of the FPL Federal Poverty Level. Children eligible for CHIP are covered under BadgerCare Plus. CHIP also covers pregnant women who are enrolled in the BadgerCare Plus Prenatal Program.
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.
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.
The following are different subprograms of Medicaid:
Home and Community Based Waivers Long-Term Care and IRIS Include, Respect, I Self-Direct
Institutional Long-Term Care Medicaid
Managed long-term care programs (Family Care, Family Care Partnership, PACE Program of All-Inclusive Care for the Elderly)
MAPP Medicaid Purchase Plan
SSI Supplemental Security Income. A program based on financial need operated by the Social Security Administration that provides monthly income to low income people who are age 65 or older, blind or disabled. Medicaid
Wisconsin Well Woman Medicaid
Emergency Services for Non-Qualifying Immigrants (limited benefit)
Medicare Savings Programs (limited benefit): QMB Qualified Medicare Beneficiary, SLMB Specified Low-Income Medicare Beneficiary, SLMB+ Specified Low-Income Medicare Beneficiary Plus, QDWI Qualified Disabled and Working Individual
SeniorCare (limited benefit)
It is possible for individuals to qualify for both BadgerCare Plus and EBD Medicaid based on financial and non-financial eligibility criteria. See Chapter 49 Health Care Choice for more information.
A person can apply for BadgerCare Plus:
Online using ACCESS
By phone by calling the IM income maintenance consortium or tribal agency
In-person at the IM income maintenance consortium or tribal agency
By mail using a paper application
A person can also apply through the FFM Federally-Facilitated Marketplace (also known as the Marketplace or the Exchange). Applications for BadgerCare Plus or Medicaid may be filed with the Federally-Facilitated Marketplace, run by the U.S. Department of Health and Human Services. The Marketplace will assess their applicants as potentially eligible for the State’s Medicaid or CHIP programs, and, if found potentially eligible, will transfer individual accounts to the income maintenance agency for a full determination. Individuals who apply at income maintenance agencies or ACCESS and are found ineligible for Medicaid or CHIP will be sent to the Marketplace..
This page last updated in Release Number: 20-04
Release Date: 11/23/2020
Effective Date: 11/23/2020