This page last updated in Release Number: 17-01
Release Date: 04/11/2017
Effective Date: 04/11/2017

18.5 Losing an Extension

18.5.1 Introduction
18.5.2 Leaving Wisconsin

18.5.1 Introduction

A BadgerCare Plus member loses an extension if one or more of following happens:

He or she fails to cooperate in providing third party health insurance coverage (TPLThird Party Liability. The obligation of a person or organization other than Medicaid or BadgerCare Plus to pay for a person's medical expenses. Examples of TPL include group or private health insurance, auto insurance, worker's compensation, and personal liability insurance.). Children under 19 are exempt from any penalty for not cooperating with this requirement.

All children under the parent's or caretaker relative’s care have either left the household or turned 19 and the extension was based on an increase in earned income.
A child in an earned income extension turns 19.
He or she fails to provide verification of income and at least one parent/caretaker in the extension AG is not disabled, a tribal member, or pregnant. Only the non-disabled, non-tribal, non-pregnant parents/caretakers are ineligible for failure to provide verification. The other members of the family in the extension remain eligible for the duration of the extension.

He or she fails to pay a premium or quits BadgerCare Plus (see Section 19.11 BadgerCare Plus Restrictive Re-enrollment Period). Only the parents/caretakers that owed the premium (those in the BCPM AG) are put into a restrictive re-enrollment period. The other members of the family in the extension remain eligible for the duration of the extension.

Note: Children in a support extension who turn 19 do not lose the extension just for turning 19. Similarly a parent or caretaker relative in a support extension does not lose the extension just because all of the children under his or her care either left the home or turned 19.

Note: An assistance group does not need to maintain employment in order to maintain an earned income extension.

If a condition necessary for an extension is lost, the extension is not regained solely by recovering the lost condition.

Example 1: A group has an extension and the parent fails to provide verification of earnings. The parent loses eligibility for BadgerCare Plus. The children in the extension remain eligible for the duration of the extension. The parent does not regain the extension if he or she later provides verification of income.

18.5.2 Leaving Wisconsin

If a BadgerCare Plus member is eligible for an extension and moves out of Wisconsin, he or she loses the extension. He or she can regain the extension if he or she returns and becomes a Wisconsin resident again during any month in the original extension period.

Example 2: Earl, a Wisconsin resident, received a 12-month extension beginning January 1, 2015. He moved out of state, thus losing his extension. On May 1, 2015, he moved back to Wisconsin and became a Wisconsin resident again. He regained the extension at the time he moved back to Wisconsin and became a Wisconsin resident.

If the time period of the extension expires while the person is out of state, he or she does not regain the extension.

Example 3: Gloria, a Wisconsin resident received a 12-month extension beginning January 1, 2015. She moved out of state, thus losing her extension. In February 2016, she moved back to Wisconsin and became a Wisconsin resident again. She does not regain the extension because the time period has expired.

This page last updated in Release Number: 17-01

Release Date: 04/11/2017

Effective Date: 04/11/2017