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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
19.10.1 Decreased premium amount 19.10.2 Increased premium amount
19.10.2.2 Effective dates of premium increase (Person Add)
19.10.2.3 Effective dates of premium increase (other than person adds)
When a change is reported that results in a lower premium amount, it is effective during the month in which the change occurred or the month in which it was reported, whichever is later. The fiscal agent will refund any excess premium that was paid.
You must give a 10-day notice to the member when the group is required to pay a premium for the first time or is required to pay a higher premium. The increase is effective the following month if BadgerCare Plus eligibility is confirmed before adverse action . If the change is confirmed after adverse action, the increase is not effective until the month after the following month.
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Example 1: Jessica has BadgerCare Plus with a premium for her and her family. She reports a change in income to her worker on April 23rd that results in a higher premium amount. Jessica’s premium amount will increase effective June 1st. She will receive the coupon for the new premium amount at the end of May. |
If the person add will cause an increase in the premium, CARES will not allow eligibility confirmation if the notice requirement cannot be met. Certify eligibility for new members through the FowardHealth Portal. If unable to certify through the ForwardHealth Portal, complete and return the F-10110 (formerly DES 3070) for the days that cannot be confirmed in CARES. See Process Help 81.
ForwardHealth iChange
P.O. Box 7636
Madison, WI 53707-7636
Fax: (608) 221-8815
| Example 2: Rachel’s husband Mike moved back into the home on June 1st. She reported the change on June 6th and the agency processed the change on June 10th (before adverse action). Inclusion of Mike’s income resulted in a premium increase. The increase is effective July 1st. Certify Mike’s BadgerCare Plus eligibility effective June 6th by sending in a F-10110 for the dates between June 6th and June 30th. |
| Example 3: Ann moved back to her parent’s home on December 12th and reported it on the 22nd (after adverse action). The agency acted to process the change on the same day. Inclusion of Ann’s income resulted in a premium increase. The premium increase is not effective until February 1st. Certify Ann’s BadgerCare Plus eligibility effective December 22nd by submitting an F-10110 for the dates between December 22nd and January 31st. |
A delay in the effective date of premium increases must also be done in certain ongoing cases that may or may not include a person add. These are cases where a change results in an assistance group opening up and has new or increased premiums for a month (or months) that cannot be confirmed in CARES. In these situations, the member is not responsible for a premium payment (or a premium increase) for the month or months that cannot be confirmed in CARES. The first premium (or increased premium) for which the family must pay is the one for the month for which eligibility can be confirmed.
The following situations qualify for this treatment:
Effective April 1, 2014, a case reports a decrease in income from above 300% to below 300% and the child(ren) are now eligible with a premium.
In a situation where other members in the AG or in another BadgerCare Plus AG may owe a premium, treat their premium separately from the newly eligible members and/or AG. Through March 31, 2014, a family that owes a small premium for the children but then has an income decrease to below 200% of the Federal Poverty Level (FPL) that causes the parents to be eligible for a larger premium. With the income change, the children no longer owe a premium. If the premium was already paid for the children, that amount must be refunded. If the premium was not paid, the children should not be sanctioned for non-payment since they no longer owe a premium.
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Example 4: June and Ward Cleaver are receiving BadgerCare Plus for their two sons, Wally and Theodore. The family income is 205% of the Federal Poverty Level (FPL), and they are paying $20 in monthly premiums for the boys. On March 25, Ward reports a decrease in wages and the family’s income is now 191% of the FPL. This makes June and Ward eligible for BadgerCare Plus with a premium. When the IM worker runs eligibility for May, the new BadgerCare Plus premium amount is $213. CARES will not allow the worker to confirm eligibility for March or April because their premium is higher than the $20 amount that had already been confirmed for the children. The worker needs to:
In addition, since the sons are no longer required to pay a premium and are now eligible for the Standard Plan, the worker must also update their medical status code using the online or manual F-10110. Once the medical status is updated in iC to a non-premium status, HP will automatically refund the $20.00 premium that was paid. |
| Example 5: Mary and Tom apply for BadgerCare Plus on May 1, 2014 for their son, Sam, and Mary’s daughter, Sara. Mary and Tom are not married and both plan to file taxes. Mary claims Sara as a dependent and Tom claims Sam. Sara’s AG income is 208%, so she has a $10 premium. Sam’s AG income is at 310%, so he is not eligible for BadgerCare Plus. The case is confirmed on May 15, 2014 with Sara’s eligibility beginning May 1, 2014. On June 1st, Tom reports his income decreased in late March, resulting in Sam’s AG income to decrease to 265%. Sam would now be eligible with a $44 premium. Because CARES will not allow the worker to confirm the increase in premium for June, Sam will not be required to pay a premium until July 1, 2014, although he will be eligible as of June 1, 2014. Sara is still required to pay her $10 June premium, and the combined premium of $54 will be effective July 1, 2014. |
This page last updated in Release Number: 14-01
Release Date: 02/07/14
Effective Date: 02/01/14
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.
Publication Number: P-10171