State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

20-03 Version of 19.8 Non-Payment

19.8.1 Non-Payment Introduction

The failure to pay a premium does not affect the eligibility of any person in the household who does not have a premium obligation. If an individual or family with a premium obligation fails to pay the premium by adverse action of the benefit month, BadgerCare Plus will close for those individuals who owed a premium. They will not be eligible for BadgerCare Plus for three calendar months, called an RRPRestrictive Re-enrollment Period. The period of time an individual is not eligible to enroll in BadgerCare Plus due to non-payment of a premium., unless there is good cause (see Section 19.8.3 Good Cause for Non-Payment) or they pay the late premiums (see Section 19.11 BadgerCare Plus Restrictive Re-enrollment Period).

The total premium amount for a case must be paid to avoid being considered late or unpaid. No partial premium payments will be accepted.

19.8.2 Insufficient Funds

If a BadgerCare Plus member pays the monthly premium through EFT or direct payment by check, and the payment is rejected for insufficient funds it is considered a non-payment and the BadgerCare Plus eligibility will terminate. A restrictive re-enrollment (see Section 19.11 BadgerCare Plus Restrictive Re-Enrollment Period) will be applied unless there is good cause (see Section 19.8.2 Insufficient Funds). The RRP begins with the first month after closure. If an overpayment occurred, a benefit recovery claim should be established.

19.8.3 Good Cause for Non-Payment

Do not apply an RRP for non-payment if good cause exists. Good cause reasons for not paying the BadgerCare Plus premium are:

1. Problems with the financial institution.
2. CARESThis system supports the Income Maintenance operations for DHS and DCF. CARES is used to determine eligibility, issue benefits, track premium payments, and manage support for BadgerCare Plus, EBD Medicaid, W-2, Child Care, and Work Programs. problem.
3. Local agency problem.
4. Wage withholding problem.
5. Fair hearing decision.

The member must still pay the arrears before eligibility will begin again.

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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