19.11 BadgerCare Plus Restrictive Re-enrollment Period

19.11.1 Restrictive Re-Enrollment Period Introduction
19.11.2 Reinstatement
19.11.3 Reapplying

19.11.1 Restrictive Re-Enrollment Period Introduction

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.

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.

Example 2: Jim’s son, Chad, is open for BadgerCare Plus with a premium. Adverse action is September 16. Jim has not paid his son's September premium by September 16. He pays on October 26. Chad's BadgerCare Plus closed on September 30 due to not paying the premium. Jim must pay both of Chad’s premiums for September and October before Chad’s 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.

19.11.2 Reinstatement

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 certification 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.

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.

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.

19.11.3 Reapplying

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.

This page last updated in Release Number: 18-03

Release Date: 12/14/2018

Effective Date: 12/14/2018