State of Wisconsin
Department of Health Services

Release 23-04
December 18, 2023

View History

19.5 Initial Payments

Payment of the BadgerCare Plus premium is a non-financial condition of eligibility. Initial premium payments must be made before eligibility is confirmed and the members are enrolled. The first month is free if no one in the BadgerCare Plus group was eligible for BadgerCare Plus or Medicaid in the previous month, and the BadgerCare Plus assistance group (AG) has not received a free month in the previous 12 months. Consider someone with an unmet deductible as not being eligible for BadgerCare Plus. Free months occur at application and when members reopen after serving a Restrictive Re-enrollment Period (RRP) (and not reinstating during the RRP) and no one was on BadgerCare Plus in the previous month or received a free month in the last 12 months.  

The eligibility policy and time frame procedures for premium payments are as follows:

  1. Initial eligibility date and confirmation occur in the month of application.

    When an application is processed in the same month it was received, and a premium for the initial month of eligibility is not due because they are eligible for a free month, the premium for the second month of eligibility must be paid in advance before a family can be enrolled in BadgerCare Plus.

    Example 1

    Lisa and her family applied for BadgerCare Plus on January 25. On January 31, the worker determined that the family met eligibility requirements effective January 1. Since the family had not been previously eligible for BadgerCare Plus, a premium for January was not assessed since they were eligible for the free month. However, Lisa had to pay the February premium for her family before their eligibility could be confirmed.

  2. Eligibility begins in the month of application. Confirmation occurs in a future month.

    When an application is not processed within the 30-day application processing period and the family is eligible for a free month, the family must pay both the second- and third-months’ premium before enrollment. CARES requires that premiums for both the second and third months be paid before confirmation when eligibility is processed any time in the third month.

    Example 2

    Cheryl and her family applied for BadgerCare Plus on March 25. No one in her family was eligible for BadgerCare Plus in the previous month. At Cheryl’s request, the IM worker extended the 30-day processing time period by 10 days for additional verification. The application for BadgerCare Plus was processed on May 2, but the family was determined eligible effective March 1. A premium is not due for March because it is a free month. However, Cheryl had to pay the premium amount for April and May before BadgerCare Plus eligibility could be confirmed.

  3. Eligibility begins in a future month, but application is processed in the month of application.

    When an application is processed within 30 days but eligibility does not begin until a future month, the free month is the first future month of eligibility. The family will receive an invoice for the premium amount through the mail. They must pay the premium due for the second month by the 10th of the benefit month to remain eligible for BadgerCare Plus.

    Example 3

    Arnie and his family applied for BadgerCare Plus on April 12. He and his family were determined to be eligible for BadgerCare Plus beginning May 1. A premium is not assessed for May. A coupon for Arnie’s June premium was mailed on May 20 with payment due by June 10.

This page last updated in Release Number: 23-04
Release Date: 12/18/2023
Effective Date: 12/18/2023


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