State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

19.8 Non-Payment

19.8.1 Non-Payment Introduction

19.8.2 Insufficient Funds 19.8.3 Good Cause for Non-Payment

19.8.1 Non-Payment Introduction

The failure to pay a premium does not affect the eligibility of any person in the household who does not have a premium obligation.  If an individual or family with a premium obligation fails to pay the premium by adverse action of the benefit month, BC + will close for those individuals who owed a premium.

 

• Children under age 19

• • Effective with RRPs beginning January 1, 2014 (for failure to pay December 2013 premiums), children under age 19 who do not pay their premiums will not be eligible for BadgerCare Plus for 3 calendar months, unless there is good cause (see 19.8.3). See 19.11 for more information.

  • Through December 31, 2013, children were not eligible for 6 calendar months following the date on which their coverage terminated for failure to pay premiums, unless there was good cause . However, effective April 1, 2014, any RRPs that began prior to January 1, 2014 were updated in CARES to set the RRP end date to no later than 3 months after the RRP started.

• Adults age and older

• • Beginning April 1, 2014, adults who fail to pay a premium will not be eligible for BadgerCare Plus for 3 calendar months following the date on which their coverage terminated, unless there was good cause. See 19.11 for more information.

  • Through March 31, 2014, adults are not eligible for BadgerCare Plus for 12 calendar months following the date on which their coverage terminated, unless there was good cause. However, if the adult member has served at least 3 months in an RRP as of April 1, 2014, the RRP may be lifted and the member may re-enroll at their request.

 

For more information on how RRPs can be lifted and BadgerCare Plus eligibility reinstated, see 19.11.

 

The total family premium for a case must be paid to avoid being considered late or unpaid.  No partial premium payments will be accepted.

19.8.2 Insufficient Funds

If a BadgerCare Plus member pays the monthly premium through EFT or direct payment by check, and the payment is rejected for insufficient funds it is considered a non-payment and the BadgerCare Plus eligibility will terminate.  A restrictive re-enrollment (see 19.11) will be applied unless there is good cause (19.8.2).  The RRP begins with the first month after closure.  If an overpayment occurred, a benefit recovery claim should be established.

19.8.3 Good Cause for Non-Payment

Do not apply an RRP for non-payment if good cause exists.  Good cause reasons for not paying the BC premium are:

 

1. Problems with the financial institution.

2. CARESThis system supports the Income Maintenance operations for DHS and DCF. CARES is used to determine eligibility, issue benefits, track premium payments, and manage support for BadgerCare Plus, EBD Medicaid, W-2, Child Care, and Work Programs. problem.

3. Local agency problem.

4. Wage withholding problem.

5. Fair hearing decision.

 

The member must still pay the arrears before eligibility will begin again.

 

 

 

 

 

 

This page last updated in Release Number: 14-02

Release Date: 05/14/14

Effective Date: 04/01/14

---

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