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7.1 Health Insurance Conditions of Eligibility

To prevent the crowd out of private insurance, BadgerCare Plus benefits may be denied or terminated for people who have current health insurance coverage or have access (or have had access) to certain employer-sponsored health insurance policies when those people:


The following people are exempt from the policies related to employer-sponsored health insurance access and coverage:


BadgerCare Plus Prenatal Program members are subject to different policies related to health insurance coverage. Refer to Section 7.4. Current Health Insurance Coverage for the policies regarding the rules for current coverage under the BadgerCare Plus Prenatal Program.


Health insurance conditions that impact eligibility include:


IM workers are not responsible for determining current or past access to health insurance. The process will be done through the Employer Verification of Health Insurance database (see Section Employer Verification of Health Insurance [EVHI] Database).


Childless adults are not eligible for BadgerCare Plus if they are enrolled in any part of Medicare.




This page last updated in Release Number: 17-01

Release Date: 04/11/2017

Effective Date: 04/11/2017