18.2 Increase in Earnings/Decrease in Group Size Extensions

18.2.1 Earned Income Extensions Under Non-MAGI Rules

18.2.2 Earned Income Extensions under MAGI Rules

18.3 Supplemental Security Income Exception

18.2.1 Earned Income Extensions under Non-MAGI Rules

To receive a BadgerCare Plus Extension due to an increase in earnings, a person whose eligibility is determined under non-MAGIApply to households whose eligibility is determined using BadgerCare Plus relationship rules (prior to March 31, 2014) to budget income for a household prior to transitioning to MAGI BadgerCare Plus budgeting rules. rules must meet all of the following requirements:

The income increase that caused the countable income to exceed 100 percent FPLFederal Poverty Level must be due solely to one of the following:

1. Increased earnings
2. Increased earnings along with other income (changed or unchanged)
3. A decrease in group size

He or she must be a BadgerCare Plus member with income at or below 100 percent FPL at the time the income increased to over 100 percent FPL. This also applies to a decrease in group size.

The parent, caretaker, or pregnant woman must have been enrolled in BadgerCare Plus with income that was at or below 100 percent FPL for at least three of the six months immediately preceding the month in which the income went above 100 percent FPL.

He or she must otherwise meet the BadgerCare Plus eligibility criteria for persons with income below 100 percent FPL.

He or she verified his or her income unless he or she is exempt from paying a premium.

Example 1: Mary and her two children had been enrolled in BadgerCare Plus with income below 100 percent FPL since January. Her husband Denny moved back into the house in June. When Denny was added to the case with his additional earned income, the group’s countable income went over 100 percent FPL. Because Mary and the two children were enrolled in BadgerCare Plus with income below 100 percent FPL for three of the prior six months at the time the income went above 100 percent, they are eligible for a 12-month BadgerCare Plus Extension. Denny is not included in the Extension because he was not enrolled in BadgerCare Plus at the time the income increased.

18.2.2 Earned Income Extensions under MAGI Rules

To receive a BadgerCare Plus Extension due to an increase in earnings, a parent, caretaker, or pregnant woman under MAGIModified Adjusted Gross Income. MAGI rules are used to determine BadgerCare Plus eligibility for new applicants beginning in 2014 and for existing members as of March 31, 2014, or their next regularly scheduled renewal, whichever is later. MAGI rules are based on tax relationships and family relationships, and they consider taxable income and whether children and tax dependents are required to file. rules must meet all of the following requirements:

The income increase which caused the countable income for his or her BadgerCare Plus AGassistance group to exceed 100 percent FPL must be due solely to one of the following:

1. Increased earnings (of anyone in the same AG)
2. Increased earnings along with other income (changed or unchanged)

He or she must be a BadgerCare Plus member with income at or below 100 percent FPL at the time the income increased to over 100 percent FPL.

The parent, caretaker, or pregnant woman must have been enrolled in BadgerCare Plus with income that was at or below 100 percent FPL for at least three of the six months immediately preceding the month in which the income went above 100 percent FPL.

He or she must otherwise meet the BadgerCare Plus eligibility criteria for persons with income below 100 percent FPL.

He or she verified his or her income unless he or she is exempt from paying a premium because he or she and any co-parent or spouse in the AG are disabled, a tribal member, or pregnant. (This policy applies to all adults in the AG. Unless they are all exempt from paying a premium, income must be verified.)

Note: These requirements do not apply to children eligible under MAGI rules (see Section 18.1.3 Children).

Example 2: Jane lives with her two teenage children and Dave, the non-marital co-parent of the two children. Jane is claiming both children on her taxes and her income for her MAGA AG of three is 90 percent FPL. Dave’s MAGA AG consists only of himself, and he is eligible for BadgerCare Plus with income of 95 percent FPL. The children-in-common are eligible in a MAGC AG group of four, with both parents as counted adults in their AG and their group’s income is 121 percent FPL. Jane was enrolled in BadgerCare Plus with income below 100 percent FPL for three of the prior six months. In June, her earned income increased to 120 percent FPL. She is eligible for a 12-month BadgerCare Plus Extension. Dave is not included in the Extension because he was not a counted member of Jane’s AG. The children are eligible for a 12-month Extension because they were eligible in June when Jane’s income rose above 100 percent and their own AG’s income was below 156 percent FPL at the time.

18.2.3 Supplemental Security Income Exception

A person who was eligible for SSISupplemental Security Income. A program based on financial need operated by the Social Security Administration that provides monthly income to low-income people who are age 65 or older, blind, or disabled. benefits may be eligible for a BadgerCare Plus Extension if he or she loses SSI and would have been eligible for BadgerCare Plus with countable income at or below 100 percent if he or she had not been an SSI recipient.

Example 3: Mary is receiving SSI. Her two children are enrolled in BadgerCare Plus with countable income at or below 100 percent FPL. Mary started a job and her earnings put her above the SSI income limit. Her earned income also caused the BadgerCare Plus countable income to exceed 100 percent FPL. Both Mary and her two children are eligible for a 12-month BadgerCare Plus Extension.

This page last updated in Release Number: 15-02

Release Date: 09/02/2015

Effective Date: 09/02/2015