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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
The following are the relationships and legal responsibility that determine who is in the BadgerCare Plus coverage groups:
A parent may be defined as the following:
Natural, legally adoptive, or a step-parent.
Of any age.
There can be more than one parent of a certain gender in a household.
To be considered a parent of a child younger than 19 years old for BadgerCare Plus purposes, the child must be under the care of that person at least 40 percent of the time. For example, in families where parents are divorced, if the child does not live with a parent at least 40 percent of the time, that parent would have his or her eligibility considered under the Childless Adults coverage group, rather than the Parents/Caretakers coverage group.
Note: A child younger than 19 years old residing with a parent may not apply separately from his or her parent. In addition, the parent must apply as the primary person for the case, unless the child filing the application is 18 years old.
When a woman is married at the time that she gives birth, her husband is considered the legal father of the child unless a court later determines that someone else is the father.
If the parents of the child are not married at the time of the child’s birth, paternity must be established in order to determine the parental relationship for the father. Paternity is legally established only by a court order or by a Voluntary Paternity Acknowledgment form (DPH 5024) signed on or after May 1, 1998, and filed with the state Vital Records office. A father’s name on a birth certificate issued in Wisconsin on or after May 1, 1998, is evidence that paternity has been established.
The following designations for a father are used in CARES. See the accompanying definitions to determine which designation is appropriate for a case.
Claimed father
A claimed father is someone claiming to be the father of a child but has not had his paternity established. A claimed father is not the father for BadgerCare Plus eligibility purposes. His child should be referred to the CSA so that steps to establish paternity can be taken.
Acknowledged father
An acknowledged father is someone who has not had his paternity adjudicated by a court, but has filed a formal paternity claim. An acknowledged father is one who fits one of the following criteria:
Filed paternity papers prior to May 1, 1998
Has his name on the birth certificate and the certificate is from another state or from Wisconsin and for a birth prior to May 1, 1998.
An acknowledged father is considered to be a parent for BadgerCare Plus eligibility purposes. However, because there is still no evidence of a formal adjudication, refer acknowledged fathers to the CSA so that steps to establish paternity may be taken.
Legal/adjudicated father
A father who has had his paternity legally established is called the adjudicated father. Paternity is legally established by either a court order (adjudication) or by a Voluntary Paternity Acknowledgment form signed by the father on or after May 1, 1998, that is filed with the Wisconsin Vital Records office.
Note: If a father's name appears on a Wisconsin birth certificate for a child born after May 1, 1998, it means paternity has been established. Do not refer adjudicated fathers to the CSA.
When the natural or adoptive parents of a child do not live together and have joint placement arrangements for the child (through a mutually agreed upon arrangement or court order), only one parent can be determined eligible at a time unless there is reasonably equivalent placement. Reasonably equivalent placement means that the child is residing with each parent at least 40 percent of the time during a month.
If the child is not residing with both parents at least 40 percent of the time, only the parent with the greater percentage of the placement time may apply on behalf of the child and/or for himself or herself as the caretaker relative of that child.
If only one parent of a child is applying for BadgerCare Plus and he or she is stating that he or she has placement of the child for at least 40 percent of the time, accept the declaration unless it is questionable.
If both parents are applying for BadgerCare Plus and claim the child is residing with them, act on their BadgerCare Plus cases as follows:
In determining eligibility for the parents with equivalent placement, the child is considered to be residing in both of their homes. That means the child will be included in the group size for both cases and the child’s income will also be counted in both cases.
If reasonably equivalent placement exists (as described above) and both parents apply for BadgerCare Plus for the child and the child has access to health insurance where an employer pays 80 percent or more of the monthly premium in one home but not the other, the child shall remain eligible for BadgerCare Plus on the case with the parent who does not have access to health insurance for which the employer pays 80 percent or more.
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Example 1: Johnny, age 10, lives 50 percent of the time with his mom and 50 percent of the time with his dad. Both Johnny’s dad and mom have applied for BadgerCare Plus. Mom is employed, but does not have access to health insurance coverage through her employer. Dad is employed and does have access to a family health insurance where his employer pays 81 percent of the monthly premium. Johnny can remain eligible on his mom’s case. |
If reasonably equivalent joint placement exists and both parents apply for BadgerCare Plus for the child and the income of either case requires that a premium be paid as condition of the child’s BadgerCare Plus eligibility, then the parents can choose in which case the child will receive BadgerCare Plus coverage. A premium requirement in one case does not preclude eligibility in the other parent’s case where no premium for the child would be owed.
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Example 2: Billy, age 8, lives 40 percent of the time with his dad and 60 percent of the time with his mom. Both parents are applying for BadgerCare Plus. In his mother’s case, the family income is 220 percent FPL and in his dad’s case, the family income is 180 percent FPL. Billy’s parents decide that Billy will be receiving his BadgerCare Plus coverage through Dad's case. |
If joint placement exists with a parent who lives in another state, the child must be with the Wisconsin parent at least 50 percent of the time in a month to qualify for BadgerCare Plus.
When an adult is eligible as a parent or caretaker because he or she is caring for an 18-year-old child, and that child is the only child in the home, the child must meet both the following conditions in order for the parent or caretaker to be eligible for BadgerCare Plus as a parent or caretaker of a dependent 18-year-old:
Be enrolled in high school
Be expected to graduate high school before turning 19.
The child does not have to be enrolled full time in high school in order to meet this definition of a dependent child.
The 18-year-old remains eligible as a child until he or she turns 19, regardless of school enrollment or expected date of graduation.
A caretaker relative is a non-legally responsible relative of the child under his or her care. Caretaker relatives and their spouses can be eligible for BadgerCare Plus as caretaker relatives. To be considered a caretaker relative of a child in the home, a person must first have a qualifying relationship to the child (under age 19) and the child must also be under the care of that relative.
Qualifying relationships for caretaker relatives consist of the following:
Stepfather or stepmother (when the parent is deceased or divorced/separated from the stepparent).
Natural full brother or sister, legally adopted, half- or stepbrother or sister.
Grandmother or grandfather, aunt or uncle, first cousin, nephew or niece, or any preceding generation denoted by the prefix grand-, great-, or great-great, and including those through adoption.
Note: “First cousin” includes a first cousin from a different generation, such as a first cousin once removed (i.e. the relative is taking care of his or her first cousin’s child).
Spouse of any of the above and the spouse of a child’s parent, even after the marriage ends by death, divorce, or separation.
Annulment of a marriage removes all relationships established by the marriage except parent.
A spouse is that person recognized by Wisconsin law as another person’s legal husband or wife. Wisconsin does not recognize common law marriage.
Being "under the care” means the caretaker exercises primary responsibility for the child’s care and control, including making plans for him or her. Once a child marries, he or she can no longer be considered under the care of a caretaker relative.
In cases where a child resides with both a caretaker relative and a parent, the parent is considered the caretaker relative, unless legal custody has been given by a court to the caretaker relative. In that situation, the caretaker relative is considered the caretaker relative of that child and could be eligible for BadgerCare Plus.
Note: A child under age 19 residing with a caretaker relative may not apply as the primary person for the relative’s benefits. For both a caretaker relative and a child to be included in one case, the caretaker relative must apply for BadgerCare Plus.
Parents and caretakers whose children have been placed in out-of-home care and who are having their eligibility determined or renewed are considered parents or caretakers, as the child is considered temporarily absent. However, the inclusion of the child in the parent’s group is dependent upon MAGI budgeting rules. If the child has been placed with a caretaker relative, the relative is not considered the primary caretaker of the child. If there are no other dependent children in the home, this relative is considered a childless adult for purposes of BadgerCare Plus eligibility. Inclusion of the child in the caretaker relative’s group is also dependent upon MAGI rules. See Chapter 10 Child Welfare Parents for more information.
A pregnant woman is nonfinancially eligible for BadgerCare Plus. Marital status has no effect on her nonfinancial eligibility. If she is a pregnant minor, she does not have to be under the care of or related to the caretaker to be eligible for BadgerCare Plus.
If there is a pregnant woman in the group, include the number of expected babies in the group size. Verification of the number of expected babies is not required unless questionable. If the number of babies is unknown, add 1 to the group size.
This coverage group was formerly referred to as Youth Exiting Out of Home Care.
BadgerCare Plus benefits are available to certain people who were in out-of-home care, including foster care, court-ordered Kinship Care, and subsidized guardianship, as of their 18th birthday. These people are categorically eligible for BadgerCare Plus. The person did not have to be in foster care in Wisconsin when he or she was 18 years old in order to be eligible for this coverage group. As of January 1, 2014, benefits are available to all Former Foster Care Youth younger than 26 years old. See Chapter 11 Foster Care Medicaid for additional eligibility criteria for Former Foster Care Youth.
Note: If the primary person is a Former Foster Care Youth and younger than 26 years old, then the BadgerCare Plus group includes the youth and his or her spouse if the spouse is also a Former Foster Care Youth.
A child younger than 19 years old is nonfinancially eligible for BadgerCare Plus. Marital status and school enrollment status have no effect on his or her nonfinancial eligibility. The child does not have to be under the care of or related to the caretaker to be eligible for BadgerCare Plus.
Note: A child younger than 19 years old residing with a caretaker relative may not apply as the primary person for the relative’s benefits. For both a caretaker relative and a child to be included in one case, the caretaker relative must apply for BadgerCare Plus. A child younger than 19 years old residing with a parent may not apply separately from his or her parent. In addition, the parent must apply as the primary person for the case, unless the child filing the application is age 18. People older than 19 years old must always apply separately from their parents or caretakers, irrespective of their living arrangement or tax dependency.
A childless adult is a person 19 to 64 years old who is not receiving Medicare and who does not have any dependent children younger than 19 years old who reside with him or her at least 40 percent of the time. Marital status has no effect on a person being a childless adult.
This page last updated in Release Number: 17-04
Release Date: 12/13/2017
Effective Date: 12/13/2017
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