State of Wisconsin Department of Health Services

HISTORY

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

32.2 Eligibility

 

32.2.1 Current Enrollment in Ongoing Health Care Benefits

An applicant is not eligible for temporary enrollment if he or she is already receiving ongoing health care benefits. Table 1 describes the situations where this applies.

 

Table 1: Current Enrollment in Ongoing Health Care or Family Planning Only Services Coverage
Applicant is currently enrolled in:	Applicant is applying for temporary enrollment in BadgerCare Plus:	Applicant is applying for temporary enrollment in Family Planning Only Services:
BadgerCare Plus or other ongoing Medicaid coverage	Deny temporary enrollment	Deny temporary enrollment
Family Planning Only Services	Allow temporary enrollment*	Deny temporary enrollment
*If all other temporary enrollment criteria are met

32.2.2 Temporary Enrollment Within the Last 12 Months

An applicant may only be temporarily enrolled once in a rolling 12-month period, or once per pregnancy. Table 2 describes the situations where this applies.

 

Table 2: Temporary Enrollment Within the Last 12 Months
Applicant was temporarily enrolled in:	Applicant is applying for temporary enrollment in BadgerCare Plus (non-pregnant woman):	Applicant is applying for temporary enrollment in BadgerCare Plus (pregnant woman):	Applicant is applying for temporary enrollment in Family Planning Only Services:
BadgerCare Plus (non-pregnant woman)	Deny temporary enrollment	Allow temporary enrollment*	Allow temporary enrollment*
BadgerCare Plus (pregnant woman)	Deny temporary enrollment	Allow temporary enrollment* as long as the previous temporary enrollment was not for the same pregnancy	Allow temporary enrollment*
Family Planning Only Services	Allow temporary enrollment*	Allow temporary enrollment*	Deny temporary enrollment
No programs	Allow temporary enrollment*	Allow temporary enrollment*	Allow temporary enrollment*
*If all other temporary enrollment criteria are met

32.2.3 Temporary Enrollment in BadgerCare Plus

32.2.3.1 Children

A child may get temporary enrollment for BadgerCare Plus if he or she meets all of the following financial and non-financial criteria:

• Be age 18 or younger. Children younger than age 18 must apply with a parent or guardian unless the child is living independently.
• Be a U.S. citizen or lawfully present in the U.S. (there is no requirement for the amount of time the person is lawfully present in the US).
• Has household income that is at or below the FPLFederal Poverty Level for the child’s age:
• • Younger than age 1: 306 percent of the FPL.
  • Age 1 through 5: 191 percent of the FPL.
  • Age 6 through 18: 156 percent of the FPL.

 

Note: See Section 16.1.2 Income Under Modified Adjusted Gross Income Rules for additional information on MAGI income disregards.

32.2.3.2 Pregnant Women

A pregnant woman may get temporary enrollment for BadgerCare Plus if she meets all of the following financial and nonfinancial criteria:

• Be pregnant. (Verification of pregnancy is not required.)
• Be a U.S. citizen or lawfully present in the U.S. (There is no requirement for the amount of time the person is lawfully present in the U.S.).
• Has household income that is at or below 306 percent of the FPL.
• Has not been temporarily enrolled for BadgerCare Plus for Pregnant Women at any time during her current pregnancy.

 

Note: Temporary enrollment in BadgerCare Plus for pregnant women only covers ambulatory pregnancy-related care. An application for ongoing health care benefits is required for inpatient services, including the delivery.

32.2.3.3 Adults

An adult (parent, caretaker, and childless adult) may get temporary enrollment for BadgerCare Plus if he or she meets the following financial and non-financial criteria:

• Has assistance group income at or below 100 percent of the FPL.
• Is not currently receiving Medicare Part A or B (applies to childless adults only).
• Meets one of the following:
• • Is a U.S. citizen
  • Has been lawfully residing in the U.S. for at least five years
  • Is lawfully residing in the U.S. and is a refugee or is seeking asylum
  • Is from Cuba or Haiti and is lawfully residing in the U.S.
  • Is lawfully residing in the U.S. under one of the eligible immigration statuses listed in Section 4.3.4 Immigration Status Chart.

32.2.3.4 Former Foster Care Youth

A Former Foster Care Youth may get temporary enrollment for BadgerCare Plus if he or she meets all of the following nonfinancial criteria:

• Be age 18 through 25.
• Had been receiving Foster Care, subsidized guardianship, or court-ordered Kinship Care on the date that he or she turned 18.
• Meet citizenship or immigration criteria for the population above that applies to them.

 

There is no income limit for Former Foster Care Youth.

32.2.3.5 Inmates

Qualified hospitals can make presumptive eligibility determinations for patients who are inmates of public correctional institutions (for example, county jails) as long as those patients are expected to remain in the hospital for 24 hours or more. The presumptive eligibility determination process for these patients is the same as for the populations listed above. Inmates of a state correctional facility are not eligible for temporary enrollment in BadgerCare Plus or Family Planning Only Services.

32.2.4 Temporary Enrollment in Family Planning Only Services

Refer to Section 40.2 Presumptive Eligibility for information.

 

 

 

This page last updated in Release Number: 18-01

Release Date: 04/13/2018

Effective Date: 04/13/2018

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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