|
State of Wisconsin |
Release 24-01 |
Non-exempt children with an assistance group income above 201% of the Federal Poverty Level (FPL) will be charged premiums. Each child’s premium will be based on their own assistance group’s (AG) size and income. The 5% cap for the cost of total household premiums for children will continue to apply. The cap will be 5% of the income of the premium assistance group with the highest countable income amount. The total household’s premiums will be determined based on the combined amount of all children’s premiums or the 5% cap, whichever amount is less. See Section 19.2 Premium Calculations and Section 19.3 Premium Limits for more information on premium caps.
The below table outlines the premium amounts for children.
| FPL Income Range | Above 201% to 210.99% | 211% to 220.99% | 221% to 230.99% | 231% to 240.99% | 241% to 250.99% | 251% to 260.99% | 261% to 270.99% | 271% to 280.99% | 281% to 290.99% | 291% to 300.99% | 301% to 306.00% |
| Premium Amounts | $10 | $10 | $10 | $15 | $23 | $34 | $44 | $55 | $68 | $82 | $97.53 |
| Note |
Children in extensions are not charged premiums (see Section 19.1 BadgerCare Plus Premiums). |
A child cannot be charged a new or increased premium during their 12-month continuous coverage period, but their premium may be reduced, if applicable. If the premium is lowered, that new amount becomes their premium cap for the rest of the 12-month period. If the AG’s size and income changes during the 12-month period, the child’s premium amount may not align with the FPL percentage of the AG’s income, as shown in the table above.
The table below displays the 5% caps of BadgerCare Plus premiums for children in certain households with incomes above 201% and at or below 306% of the FPL. Families are charged the combined premiums for the children but no more than 5% of the family’s countable income.
| Example 1 | A family with 11 children and an income of 295% of the FPL would ordinarily owe premiums amounting to 11 times $82, which equals $902. However, if the children’s assistance group size, including the parent, is 12, the 5% cap found in the table below is $900. That is the maximum premium amount that the family should be charged for that month. |
| Group Size | 201 - 211% | 211% - 221% | 221 - 231% | 231 - 241% | 241 - 251% | 251 - 261% | 261 - 271% | 271 - 281% | 281 - 291% | 291 - 301% | 301% - 306% |
| 1 | $126.00 | $132.00 | $138.00 | $144.00 | $151.00 | $157.00 | $163.00 | $170.00 | $176.00 | $182.00 | $188.00 |
| 2 | $171.00 | $179.00 | $188.00 | $196.00 | $205.00 | $213.00 | $222.00 | $230.00 | $239.00 | $247.00 | $256.00 |
| 3 | $216.00 | $227.00 | $237.00 | $248.00 | $259.00 | $270.00 | $280.00 | $291.00 | $302.00 | $313.00 | $323.00 |
| 4 | $261.00 | $274.00 | $287.00 | $300.00 | $313.00 | $326.00 | $339.00 | $352.00 | $365.00 | $378.00 | $391.00 |
| 5 | $306.00 | $321.00 | $336.00 | $352.00 | $367.00 | $382.00 | $397.00 | $413.00 | $428.00 | $443.00 | $458.00 |
| 6 | $351.00 | $368.00 | $386.00 | $403.00 | $421.00 | $438.00 | $456.00 | $473.00 | $491.00 | $508.00 | $526.00 |
| 7 | $396.00 | $416.00 | $435.00 | $455.00 | $475.00 | $495.00 | $514.00 | $534.00 | $554.00 | $573.00 | $593.00 |
| 8 | $441.00 | $463.00 | $485.00 | $507.00 | $529.00 | $551.00 | $573.00 | $595.00 | $617.00 | $639.00 | $661.00 |
| 9 | $486.00 | $510.00 | $535.00 | $559.00 | $583.00 | $607.00 | $631.00 | $656.00 | $680.00 | $704.00 | $728.00 |
| 10 | $531.00 | $558.00 | $584.00 | $610.00 | $637.00 | $663.00 | $690.00 | $716.00 | $743.00 | $769.00 | $796.00 |
| 11 | $576.00 | $605.00 | $634.00 | $662.00 | $691.00 | $720.00 | $748.00 | $777.00 | $806.00 | $834.00 | $863.00 |
| 12 | $621.00 | $652.00 | $683.00 | $714.00 | $745.00 | $776.00 | $807.00 | $838.00 | $869.00 | $900.00 | $931.00 |
| 13 | $666.00 | $699.00 | $733.00 | $766.00 | $799.00 | $832.00 | $865.00 | $899.00 | $932.00 | $965.00 | $998.00 |
| 14 | $711.00 | $747.00 | $782.00 | $818.00 | $853.00 | $888.00 | $924.00 | $959.00 | $995.00 | $1,030.00 | $1,066.00 |
This page last updated in Release Number: 24-01
Release Date: 04/03/2024
Effective Date: 02/01/2024
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