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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
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.
A 10-day notice must be given to the member when the group is required to pay a premium for the first time or is required to pay a higher premium. The increase is effective the following month if BadgerCare Plus eligibility is confirmed before adverse action. If the change is confirmed after adverse action, the increase is not effective until the month after the following month.
| Example 1 |
Jessica has BadgerCare Plus with a premium for her and her family. She reports a change in income to her worker on April 23 that results in a higher premium amount. Jessica’s premium amount will increase effective June 1. She will receive the coupon for the new premium amount at the end of May. |
If the person add will cause an increase in the premium, CARES will not allow eligibility confirmation if the notice requirement cannot be met.
See also Process Help, Chapter 81 ForwardHealth iChange.
| Example 2 |
Rachel’s husband Mike moved back into the home on June 1. She reported the change on June 6 and the agency processed the change on June 10 (before adverse action). Inclusion of Mike’s income resulted in a premium increase. The increase is effective July 1. Mike’s BadgerCare Plus eligibility must be manually certified for the dates between June 6 and June 30. |
| Example 3 |
Ann moved back to her parent’s home on December 12 and reported it on December 22 (after adverse action). The agency acted to process the change on the same day. Inclusion of Ann’s income resulted in a premium increase. The premium increase is not effective until February 1. Ann’s BadgerCare Plus eligibility must be manually certified for the dates between December 22 and January 31. |
A delay in the effective date of premium increases must also be done in certain ongoing cases that may or may not include a person add. These are cases where a change results in an assistance group opening up and has new or increased premiums for a month (or months) that cannot be confirmed in CARES. In these situations, the member is not responsible for a premium payment (or a premium increase) for the month or months that cannot be confirmed in CARES. The first premium (or increased premium) for which the family must pay is the one for the month for which eligibility can be confirmed.
The following situations qualify for this treatment:
A case reports a decrease in income from above 306% to below 306% and the child(ren) are now eligible with a premium.
| Example 4 |
Mary and Tom apply for BadgerCare Plus on May 1 for their son, Sam, and Mary’s daughter, Sara. Mary and Tom are not married and both plan to file taxes. Mary claims Sara as a dependent and Tom claims Sam. Sara’s AG income is 208%, so she has a $10 premium. Sam’s AG income is at 310%, so he is not eligible for BadgerCare Plus. The case is confirmed on May 15 with Sara’s eligibility beginning May 1. On June 1, Tom reports his income decreased in late March, resulting in Sam’s AG income to decrease to 265%. Sam would now be eligible with a $44 premium. Because CWW will not allow the worker to confirm the increase in premium for June, Sam will not be required to pay a premium until July 1, although he will be eligible as of June 1. Sara is still required to pay her $10 June premium, and the combined premium of $54 will be effective July 1. |
This page last updated in Release Number: 20-03
Release Date: 08/03/2020
Effective Date: 08/03/2020
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