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State of Wisconsin |
Release 24-01 |
Federal law requires that once a person has been determined eligible for Elderly, Blind, or Disabled (EBD) Medicaid, they must be enrolled in EBD Medicaid, even if they are also eligible for BadgerCare Plus, unless they have a change in circumstances that results in ineligibility for EBD Medicaid. The only exception to this policy is pregnant people who are eligible for both EBD Medicaid and BadgerCare Plus. In these instances, the pregnant person will be enrolled in BadgerCare Plus.
If a person is pending for EBD Medicaid or if a person has an unmet deductible for EBD Medicaid, they are not considered eligible for EBD Medicaid and can enroll in BadgerCare Plus. Pending for EBD Medicaid includes, but is not limited to, waiting for a disability determination from the Disability Determination Bureau (DDB) or not eligible for Medicare. If a person enrolled in EBD Medicaid becomes ineligible for EBD Medicaid for any reason, including going over the asset limit or failure to pay a Medicaid Purchase Plan (MAPP) premium, they can enroll in BadgerCare Plus if they are still eligible to do so.
People who are eligible for both Wisconsin Well Woman Medicaid and BadgerCare Plus should be enrolled in Wisconsin Well Woman Medicaid.
See the Medicaid Eligibility Handbook, Chapters 24 - 38 for more information about the Medicaid subprograms.
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EBD Eligibility |
BadgerCare Plus Eligibility |
System Choice |
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MS/NS/MAPP w/no premium |
No premium |
EBD |
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MS/NS/MAPP w/no premium |
Premium |
EBD |
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MS/NS/MAPP w/o premium |
BadgerCare Plus Deductible |
EBD |
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MAPP w/premium |
No premium |
BadgerCare Plus |
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NS Deductible |
No premium |
BadgerCare Plus |
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MAPP w/premium |
Premium |
The program with the lesser premium |
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NS Deductible |
Premium |
Member Choice |
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MAPP Premium |
Deductible |
Member Choice |
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NS Deductible |
Deductible |
Member Choice |
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