19.7 Refunds

A refund must be issued if the premium was paid and is for a month in which one of the following situations occurs:

The individual or household was ineligible for BadgerCare Plus.
A change is reported that results in no premium or a lower premium amount.
1. If the change is reported within 10 days of when the change occurred, the lower or $0 premium amount is effective during the month in which the change occurred.
2. If the change is not reported within 10 days of when the change occurred, the lower or $0 premium amount is effective during the month in which it was reported. The fiscal agent will refund any excess premium that was paid. See Section 27.2 Nonfinancial Change Reporting and Section 27.3 Income Change Reporting Requirements for information on change reporting.

Note	When determining if a change was reported within 10 days of when the change occurred, the reported date of change from the member is used. If the worker has information that makes the reported date of change questionable, verification of the date of change may be required.

Premium decreases must be reviewed, and eligibility redetermined when applicable, when coverage was maintained following a reported change or a timely renewal. Once eligibility is able to be redetermined, premium amounts for months with coverage maintained may need to be refunded. See Process Help 23.1.3 Premium Refunds.

Example 1

David and Jenny are married and have a child, Megan. Their household income is 285% of the FPL. Megan is enrolled in BadgerCare Plus with a $68 monthly premium. In June, David had a decrease in work hours. At the end of June, David and Jenny found that this reduction in work hours resulted in the household income decreasing to 235% of the FPL in the month of June. David reports this income change to the agency on July 7. Since this change was reported within 10 days of the household monthly income changing, the lower premium is effective the month in which the change occurs (June). Starting in June, Megan’s monthly premium is $15. David had already paid $68 each for Megan’s June and July premiums, so a refund must be issued.

Example 2

Morgan and Taylor are married and have a child, Kelly. Their household income is 285% of the FPL. Kelly is enrolled in BadgerCare Plus with a $68 monthly premium. In June, Morgan has a decrease in work hours. At the end of June, Morgan and Taylor found that this reduction in work hours resulted in the household income decreasing to 235% of the FPL in the month of June. Morgan reports this income change to the agency on July 18. Since this change was reported more than 10 days after the household monthly income changed, the lower premium amount is effective during the month in which it was reported (July). Starting in July, Kelly’s monthly premium is $15. Morgan already paid $68 for Kelly’s July premium, so a refund must be issued.

Example 3

Aaron has a child, Emily. Their household income for a group of 2 is 285% of the FPL. Emily is enrolled in BadgerCare Plus with a $68 monthly premium. On September 4, Aaron marries Kathy. Aaron contacts his agency on September 13 to report his marriage to Kathy and add her to his household. Kathy's income must be verified by October 3. Emily’s BadgerCare Plus is maintained for the month of October while eligibility is pending for income verification. On October 3, the income verification is processed. Their household income for a group of 3 is 225% of the FPL. Starting in September, Emily’s monthly premium is $10. Aaron had already paid $68 each for Emily’s September and October premiums, so a refund must be issued.

This page last updated in Release Number: 25-04
Release Date: 12/10/2025
Effective Date: 12/10/2025