19-01 Version of 18.5 Losing an Extension

18.5.1 Introduction
18.5.2 Regaining Extensions
1. 18.5.2.1 Leaving Wisconsin and Regaining Extensions

18.5.1 Introduction

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

They fail 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 younger than 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, or the parent is no longer cooperating with a reunification plan, and the extension was based on an increase in earned income.
A child in an earned income extension turns 19.

Note

Children in a support extension who turn 19 years old 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 their care either left the home or turned 19. Members may continue to be eligible through the end of the extension period unless they meet any of the criteria listed above.

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

18.5.2 Regaining Extensions

If a condition necessary for an extension is lost and the extension is closed for a full calendar month, the extension is not regained solely by recovering the lost condition.

If an extension is terminated for failure to verify information, eligibility for the unexpired extension cannot be regained by later providing the verification if it is more than a month after closure.

If an earned income extension ends because all children have turned 19 years old or left the household, but the child(ren) return to the household within the calendar month after the closure, the child and any people who qualify again as a parent or caretaker of that child(ren) may reopen under an unexpired earned income extension.

Example 1

Bob, his wife Betty, and their only child Ben are open for an earned income extension until May 31. Their eligibility ended on January 31 because Ben left the household. It was reported that Ben returned to the household on February 13. Because it was reported that the child returned to the home within a calendar month, they may regain eligibility for their earned income extension until May 31.

However, people would be able to regain eligibility for an unexpired extension, even after being closed for more than a calendar month, in the following scenarios:

They move out of the state and return before the extension ends (see Section 18.5.2.1 Leaving Wisconsin and Regaining Extensions).
They de-request BadgerCare Plus after their extension has started (that is, the extension has been built and confirmed) and later request to reinstate for the remaining months of an unexpired extension.

Example 2

Bobby and his two children, Maria and David, are open for BadgerCare Plus (not in an extension). Bobby reports an increase in income on May 2. His increased earnings push the household income from 80% FPL to 160% FPL. The worker processes the change and confirms eligibility on May 8. Bobby and his family are determined eligible under a BadgerCare Plus extension starting June 1. However, Bobby changes his mind and de-requests BadgerCare Plus on May 12. Because it is before adverse action, their BadgerCare Plus will close effective May 31. Bobby contacts the agency on June 20, saying that he does want the coverage for his family under the extension. Even though he de-requested before June, the extension was built and confirmed, so Bobby’s family can reinstate for the remainder of the unexpired extension.

18.5.2.1 Leaving Wisconsin and Regaining Extensions

If a BadgerCare Plus member is eligible for an extension and moves out of Wisconsin, they lose the extension. They can regain the extension if they return and become a Wisconsin resident again during any month in the original extension period.

Example 3

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, they do not regain the extension.

Example 4

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: 19-01
Release Date: 04/19/2019
Effective Date: 01/01/2019