State of Wisconsin
Department of Health Services
Release 20-03 August 3, 2020
48.1.1 Premiums for Children
48.1.3 Five Percent Premium Caps for Children
Non-exempt children with an assistance group income above 201 percent of the FPL Federal Poverty Level will be required to pay premiums. Each child’s premium will be based on his or her own assistance group’s size and income. The five percent cap for the cost of total household premiums for children will continue to apply. The cap will be five percent of the income of the premium paying 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 five percent 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.
Note: Children in extensions are not required to pay premiums (see Section 19.1 BadgerCare Plus Premiums). If a parent in the household is in an extension, the children are exempt from paying premiums regardless of their income.
The table below displays the five percent caps of BadgerCare Plus premiums for children in certain households with incomes above 201 percent and below 306 percent of the FPL. Families will pay the combined premiums for the children or an amount equal to five percent of the family’s countable income, whichever is less. For example, a family with six children and an income of 295 percent of the FPL would ordinarily owe premiums amounting to six times $82, which equals $492. However, if the children’s AG size, including the parent, is seven, the five percent cap found in the table below is $472. That is the maximum premium amount that the family should be charged for that month.
This page last updated in Release Number: 20-01
Release Date: 02/03/2020
Effective Date: 02/01/2020