19.7 Refunds

Contact the BadgerCare Plus Unit at 1-888-907-4455 to issue a refund if the premium was paid and is for a month in which one of the following situations occurs:

The individual or family was ineligible for BadgerCare Plus.
A change is reported that results in no premium or a lower premium amount. If the change is reported within 10 days of when the change occurred, the lower or $0 premium amount is effective during the month in which the change occurred. If the change is not reported within 10 days of when the change occurred, the lower or $0 premium amount is effective during the month in which it was reported. The fiscal agent will refund any excess premium that was paid. See Section 27.2 Nonfinancial Change Reporting Requirements and Section 27.3 Income Change Reporting Requirements for information on change reporting.

Note: When determining if a change was reported within 10 days of when the change occurred, the worker should use the reported date of change from the member. If the worker has information that makes the reported date of change questionable, the worker can request verification of the date of change.

Example 1: David and Jenny are married and have a child, Megan. Their household income is 285% of the FPL. Megan is enrolled in BadgerCare Plus with a $68 monthly premium. In June, David had a decrease in work hours. At the end of June, David and Jenny found that this reduction in work hours resulted in the household income decreasing to 235% of the FPL in the month of June. David reports this income change to the agency on July 7. Since this change was reported within 10 days of the household monthly income changing, the lower premium is effective the month in which the change occurs (June). Starting in June, Megan’s monthly premium is $15. David had already paid $68 each for Megan’s June and July premiums, so the IM worker must contact the fiscal agent to refund the total difference of $106 for June and July.

Example 2: Morgan and Taylor are married and have a child, Kelly. Their household income is 285% of the FPL. Kelly is enrolled in BadgerCare Plus with a $68 monthly premium. In June, Morgan has a decrease in work hours. At the end of June, Morgan and Taylor found that this reduction in work hours resulted in the household income decreasing to 235% of the FPL in the month of June. Morgan reports this income change to the agency on July 18. Since this change was reported more than 10 days after the household monthly income changed, the lower premium amount is effective during the month in which it was reported (July). Starting in July, Kelly’s monthly premium is $15. Morgan already paid $68 for Kelly’s July premium, so the IM worker must contact the fiscal agent to refund the difference of $53 for July.

Example 3: Aaron has a child, Emily. Their household income for a group of 2 is 285% of the FPL. Emily is enrolled in BadgerCare Plus with a $68 monthly premium. On September 4, Aaron marries Kathy. Aaron contacts his agency on September 13 to report his marriage to Kathy and adding her to his household. Their household income for a group of 3 is 225% of the FPL. Starting in September, Emily’s monthly premium is $10. Aaron had already paid $68 for Emily’s September premium, so the IM worker must contact the fiscal agent to refund the difference of $58 for September.

Note: Premium payments may not be made in advance.

This page last updated in Release Number: 19-02
Release Date: 09/10/2019
Effective Date: 09/10/2019