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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
A member for whom a premium is owed for the current month who leaves BadgerCare Plus by not paying a premium may be subject to a restrictive re-enrollment period. An RRP means the member cannot re-enroll in BadgerCare Plus for a certain number of months from the termination date while their income remains high enough to owe a premium, unless they pay the premiums owed, meet a good cause exemption or the RRP is lifted. Members can make late premium payments at any time during their three-month RRP.
Members must pay the overdue payment(s) that resulted in case closure, but do not have to pay the premium owed for the following month, unless the late payment is made after the benefit month.
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Example 1: If a premium was owed for September, but is not paid until November, the premiums for September, October and November must be paid in order for eligibility to be restored for those months. |
If the member owes a premium for a month during the RRP, he or she must pay all owed premiums before CARES will restore eligibility for BadgerCare Plus. The member must pay the IM agency directly (not the Fiscal Agent). You can check with the Fiscal Agent to see if a premium has already been collected for that month.
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Example 2: Adverse action is September 16. Jim has not paid his September premium by September 16. He pays on October 26. His case closed on September 30. Jim must pay both the premiums for September and October before eligibility can be restored. The November premium is not due until November 10 and does not have to be paid in advance. |
Members whose income decreases to an amount that would not require a premium will be removed from the RRP and re-enrolled in BadgerCare Plus.
RRPs are set for three months.
The child can become eligible for BadgerCare Plus again at any time during the three-month RRP if all owed premiums are paid. The child’s eligibility will be restored back to the beginning of the RRP. If the person serves the full three-month penalty period, he or she may be eligible to re-enroll for the remainder of the BadgerCare Plus extension again (without paying any owed premiums) on the first of the following month after the RRP ends, if he or she continues to meet the program eligibility criteria.
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Example 3: Kayla, age 10, had a premium of $10 and failed to pay her May premium. Her BadgerCare Plus benefits ended May 31 and she was put into a three month RRP from June 1 to August 31. Eligibility can be re-determined in September OR Kayla could re-enroll prior to September if she pays all owed premiums. |
Exception: If a child becomes a member of a different case during an RRP, discontinue the RRP for that child.
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Example 4: Josh was on his mom’s case in November when she failed to pay the premium. His RRP started December 1. In January, Josh’s grandmother applied for BadgerCare Plus for Josh, reporting that Josh is now living with her as of January 5. Josh’s RRP from his mother’s case does not extend to his grandmother’s case, so Josh is eligible for BadgerCare Plus beginning with the month of January. |
RRPs are set for three months.
An adult must only pay a premium for BadgerCare Plus is if he or she is in an extension. An adult can become eligible for the remainder of the extension again at any time during the three month RRP if he or she pays all owed premiums. The adult’s eligibility will be restored back to the beginning of the RRP. If the individual serves the full three month penalty period, he or she can become eligible for the remainder of the extension (without paying any owed premiums) if he or she requests to re-enroll for the remainder of his or her extension and if he or she continues to meet the program eligibility criteria.
After the RRP has been served, eligibility can be reinstated as of any month after the end of the RRP until the end of the extension. For example, if an RRP ends June 30 for an extension that runs through December, a member could request in November to be reinstated starting July 1. However, members must pay owed premiums for any months of coverage, and the months of eligibility must be consecutive. So using the same example, the member could not request to be reinstated for July, September, October and November, but not August.
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Example 5: Joyce (age 29) is an adult in an extension. She fails to pay the June premium, so she is in a 3 month RRP for July, August and September. In August, Joyce pays her owed premiums for June, July and August. Joyce’s eligibility is restored back to the beginning of the RRP. |
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Example 6: Tina (age 45) did not pay the September premium while in an extension. Tina will be in a 3 month RRP for October, November and December. Tina contacted the IM agency in January, after she served the full 3 month RRP and requested to re-enroll in BadgerCare Plus. As long as there are still months left in the extension and she continues to meet the program eligibility criteria, Tina can re-enroll starting January without paying any owed premiums from the RRP. Tina would not be able to re-enroll for October, November and December. If Tina had contacted the agency in April, she would be able to choose whether to reinstate her enrollment starting in January, February or March, but she would not be able to choose to be covered only in February and then start coverage again in April. |
One member in a household may be in an RRP while other members in the same household are still eligible for BadgerCare Plus or ineligible under a separate RRP. For example, children in the same household as a member on RRP may remain eligible for BadgerCare Plus if no premium obligation was owed for the children.
An parent or caretaker who applies for BadgerCare Plus before the end of the RRP and whose assistance group’s income is still above the premium threshold may be eligible for BadgerCare Plus for the remainder of the existing extension if he or she pays owed premiums.
A child included on an application for BadgerCare Plus before the end of the RRP and whose assistance group’s income is still above the premium threshold may be eligible for BadgerCare Plus if his or her owed premiums are paid.
If the individual’s assistance group’s income is now below the premium threshold, he or she can become eligible for BadgerCare Plus without paying owed premiums.
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Example 7: Jackie, John and their three children are open for BadgerCare Plus. Jackie and John are in an extension and have a premium. The children are eligible without a premium. They fail to pay the June premium so Jackie and John are in a RRP from July through September. The children are still eligible. In August, Jackie and John reapply for BadgerCare Plus and report a decrease in income to 95 percent FPL. Beginning August 1, Jackie and John are again eligible for BadgerCare Plus without a premium. In addition, because their income is below the premium threshold, they are not required to pay their owed premiums first. |
This page last updated in Release Number: 18-01
Release Date: 04/13/2018
Effective Date: 04/13/2018
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