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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.
| 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, they 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.
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 by the last day of the RRP. The child’s eligibility will be restored back to the beginning of the RRP. If the person serves the full three-month penalty period, they 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 they continue to meet the program eligibility criteria.
| Example 1 |
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 1, but only if she pays all owed premiums by August 31. |
Exception: If a child becomes a member of a different case during an RRP, discontinue the RRP for that child.
| Example 2 |
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. |
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 their owed premiums are paid.
If the individual’s assistance group’s income is now below the premium threshold, they can become eligible for BadgerCare Plus without paying owed premiums.
If a member de-requests BadgerCare Plus prior to adverse action, the member’s BadgerCare Plus enrollment ends at the end of that month.
| Example 1 |
Ben, age nine, is open for BadgerCare Plus. Due to an increase in his parent’s income, Ben will owe a premium starting in October. On September 9, his parent contacts the IM agency to de-request BadgerCare for Ben. The IM agency processes this de-request and ends Ben’s BadgerCare Plus as of September 30. Ben will not enter an RRP due to not paying the October premium since he is not enrolled in BadgerCare Plus in October. |
If a member de-requests BadgerCare Plus after adverse action, the member’s BadgerCare Plus enrollment ends the end of the following month in order to provide timely negative notice. If a premium is owed for the month and is not paid, the member will enter into an RRP.
| Example 2 |
Susan, age 14, is open for BadgerCare Plus. Due to an increase in her parent’s income, Susan will owe a premium starting in October. On September 25, her parent contacts the IM agency to de-request BadgerCare for Susan. The IM agency processes this de-request and ends Susan’s BadgerCare Plus as of October 31. If Susan’s premium for October is not paid, she will enter into an RRP starting November 1. She will not be able to re-enroll in BadgerCare Plus prior to February 1 unless she pays her owed premiums. |
This page last updated in Release Number: 19-02
Release Date: 09/10/2019
Effective Date: 09/10/2019
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