1.1 BC+ Introduction

1.1.1 BadgerCare Plus Health Plans

1.1.2 Health Care Choice

1.1.3 How to Apply

BadgerCare Plus (BC+) is a state/federal program that provides health coverage for Wisconsin families. BC+ replaces the former AFDC-Medicaid, Healthy Start and BadgerCare. Potential BC+ members include:

• Children under 19 years of age,

• Pregnant women,

• Parents and caretakers of children under 19,

• Young adults leaving out of home care (such as foster care),

• Parents and caretaker relatives whose children have been removed from the home and placed in out of home care.  
   

For information on income limits see Chapter 16.1 and Chapter 50.1.

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 The legal status conferred on a non-citizen by immigration law 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.

A person is eligible if s/he meets all BC+ non-financial and financial requirements.  

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:

• 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.-related Medicaid
• MAPP Medicaid Purchase Plan
• Institutional Long Term Care
• Home and Community Based Waivers Long Term Care
• Family Care Long Term Care
• Partnership Long Term Care
• Program of All-Inclusive Care for the Elderly Anyone age 65 or older. (PACE)
• Katie Beckett
• Tuberculosis (TB Tuberculosis) -related
• Medicare Premium Assistance (MPA Medicare Premium Assistance): QMB Qualified Medicare Beneficiary, SLMB Specified Low-Income Medicare Beneficiary, SLMB+, QDWI Qualified Disabled and Working Individual;
• Emergency Medicaid
• SeniorCare

See the Medicaid Handbook for more information.

1.1.1 BadgerCare Plus Health Plans

BC+ has two major health care benefit plans: Standard and Benchmark.  The Standard Plan is for families with income at or below 200% of the Federal Poverty Level (FPL).  The Benchmark Plan which provides more limited services than the Standard Plan, is for families with income above 200% of the FPL, and for self-employed parents and Caretakers. (See Table 50.1 for FPL limits)
 

In addition, BadgerCare Plus has several limited health plans.  These include:

• Family Planning Only Services

• Prenatal Care Services

• Emergency Services

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.  

Benchmark plan members will be asked to pay a share of the cost of services provided to them.  The co-pay will be charged once per office visit.  Under the Benchmark plan, the member may be required to pay co-pays and deductibles prior to receiving services.

1.1.2 Health Care Choice

It is possible for individuals to qualify for both BC+ and Elderly, Blind and Disabled Medicaid (EBD MA).  In some circumstances, CARES Client Assistance for Re-employment & Economic Support. `This system supports the Income Maintenance operations for DHFS and DWD. CARES is used to determine eligibility, issue benefits, track premium payments and manages support for BC+, EBD Medicaid, W-2, Child Care and Work Programs 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 is effective in the next possible payment following Adverse Action The last day of the month a change can be made in CARES to affect eligibility for the following month. Adverse Action is usually 13 days prior to the last day of the month to allow for a timely notice to be generated. , unless the member requests the change be effective in the month the request to change the health plan was made.

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

• The member requests a change,

• The member’s benefit under the health plan of his or her choice ends. (This includes being placed into an unmet deductible The amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan. assistance group.)  

1.1.3 How to Apply

The following application A request for BadgerCare Plus coverage. The request must be on the Department's application or registration form and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. 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. Mail-In.

4. Telephone Interview.
    

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: 13-01

Release Date: 02/28/2013

Effective Date: 02/28/2013