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State of Wisconsin |
Release 26-01 |
A renewal is the process during which all eligibility factors subject to change are reexamined and eligibility is redetermined. For members who submit their renewal timely (see SECTION 26.1.1 TIMELY RENEWALS), existing health care coverage must be maintained until the renewal is completed.
The first required renewal for BadgerCare Plus is 12 months from the most recent certification month, except for the following:
An early renewal can only be completed at the member’s request.
A child within their continuous coverage period (see SECTION 1.2 CONTINUOUS COVERAGE FOR QUALIFYING CHILDREN) may be adversely impacted by an early renewal (for example, they could be ineligible or have a new or higher premium). However, the child will not lose coverage or be charged a new or higher premium, during their current continuous coverage period. Other household members may be renewed early and may qualify for new 12-month certification periods.
Review Dates for Time-Limited Benefits
People whose benefits are time-limited (CENs, pregnant people, people who have met a deductible, or people in an extension) have a renewal at the end of their time-limited benefit unless they are on a case with other members open for BadgerCare Plus. In this situation:
Health care renewals received by the last business day of the renewal month are considered timely. When a renewal is received timely, the member’s existing health care coverage must be maintained until the renewal is fully processed by the agency. This includes situations where the member no longer meets the requirements of their current health care category and the agency needs to request additional information to determine if the member is eligible for a different form of health care.
| Example 1 | Marta is enrolled in BadgerCare Plus. July is the last month of her certification period. On July 18, a notice is sent to inform Marta that her coverage will end July 31 because she did not yet complete her renewal. Marta's renewal is submitted on July 31 during business hours. Marta’s BadgerCare Plus coverage is reinstated for the month of August, and she is sent a notice that she is enrolled in BadgerCare Plus effective August 1 and will remain enrolled while the agency processes her renewal. On August 19, the renewal process was completed, and Marta is no longer eligible for any category of health care. Marta receives a notice that her BadgerCare Plus coverage will end September 30, in accordance with notice requirements. |
| Example 2 | Diana is open for BadgerCare Plus which is due for renewal in February. She submits her renewal on February 20. Because her renewal is timely, her benefits are maintained for March. On February 22, the worker processes the renewal and requests needed verification with a due date of March 14. On March 14, verifications are received for the renewal and eligibility is determined. Diana is enrolled in a new certification period starting April 1. There is no gap in her BadgerCare Plus enrollment. |
Health care renewals received within three months of the renewal month can be processed as a late renewal instead of requiring a new application. There is no requirement for prior health care benefits to be maintained for a late renewal. The three-month period that allows for late renewals and renewal-related verifications starts the month after enrollment ended. It does not restart when a late renewal or when a late verification has been submitted.
This policy applies to members receiving health care benefits based on a met deductible but not to members with an unmet deductible.
Late renewals are only permitted for people whose eligibility has ended because of lack of renewal, and not for other reasons.
Late renewals and renewal-related verifications must be accepted for up to three calendar months after the renewal month. Members whose health care benefits are closed for more than three months because of lack of renewal must reapply.
A late submission of an online or paper renewal form or a late renewal request by phone or in person is a valid request for health care. If verification is required to complete the renewal, the member has 20 days to provide it, even if this extends renewal processing into the fourth month after benefits closed.
| Example 1 | Jenny’s renewal is due in January. No renewal is received by January adverse action, so a notice is sent to Jenny explaining her coverage will end effective January 31. Her renewal is later received on March 10, and Jenny requested backdated coverage for February. Jenny’s income verification is due on March 30. She provides verification of February and March income by the due date and meets all other eligibility criteria for BadgerCare Plus. Her new certification period starts on February 1. |
| Example 2 | Joni's renewal is due in January. Joni did not submit a renewal by January adverse action, so a notice is sent to Joni explaining her coverage will end effective January 31. She submits a renewal on April 25, with a backdate request to February. The renewal is processed the same day, and she is asked to provide verification of her income by May 15. If Joni provides verification of her February, March and April income on or before May 15 and meets all other eligibility criteria for BadgerCare Plus, she will be enrolled in a new certification period starting on February 1. Her next renewal will be due January 31 of the following year. If Joni submits verification after the May 15 due date, a new application is required. She can request up to three–months of backdated coverage when she reapplies. |
If a health care renewal is received timely, but verifications are not provided with the renewal submission, the health care program open during the renewal month is maintained while awaiting verifications. If verification is not received by the verification due date, the requirement to maintain benefits ends and health care coverage ends.
If a health care renewal is received late, health care is not maintained while eligibility is being redetermined. Regardless of whether a renewal was received timely or late, if verifications are submitted anytime in the three months following the renewal month, health care can reopen without a new application.
During the three months following the renewal due month, any verification that was previously provided as part of the renewal process remains acceptable unless a subsequent change was reported. Only the missing verifications must be provided.
If a member has a gap in coverage and is requesting backdated coverage, verification is required for all requested months. The member will have 20 days to provide the verification.
| Example 1 | Sunny’s BadgerCare Plus renewal is due in January. She completes her renewal timely on January 5, and income verification is requested with a due date of January 25, so Health care coverage is maintained for February. Sunny does not submit the requested verification by January 25, and her BadgerCare Plus eligibility ends February 28. On April 27, she submits paystubs for March 10 and March 24, and requests a backdate to March. Verification of her current income for April is requested, with a due date of May 17. On May 17, April income verification is provided. Sunny meets the eligibility criteria for BadgerCare Plus and her new certification period begins on March 1. |
If a member has a gap in coverage because of a late renewal, late verifications, or both, the member may request coverage of the past months in which a gap in coverage occurred. Backdated coverage under the late renewal policy is available to all BadgerCare Plus members who meet program rules, including children who would not otherwise qualify for backdated coverage because their income is too high (see Section 25.8.1 Backdated Eligibility).
If a member requests coverage for past months during a late renewal, they must provide all necessary information and verifications for those months (including verification of income for all months requested). They will not be charged premiums for the past months.
| Example 1 | Marge's BadgerCare Plus renewal is due in January. No renewal is received by January adverse action. A notice of BadgerCare Plus coverage ending January 31 is sent to Marge. She calls the agency to complete a late renewal on April 15 and requests a backdate to February. Verification is requested for February, March and April. The due date is May 5. If she provides verifications for each month on or before May 5 (and she meets all other eligibility criteria), her eligibility and certification period restart as of February 1. |
If health care coverage was maintained during a renewal, and the member’s enrollment changes to a new health care program or has a reduction in their premium, their eligibility may need to be redetermined for the month(s) that coverage was maintained.
After a renewal is processed, if a member’s enrollment changes from a limited-benefit to a full-benefit health care program, the eligibility in the new program may need to be redetermined for the months that coverage was maintained and any month in which the member may be eligible for the new health care program.
| Example 1 | Tom is enrolled in Family Planning Only Services (FPOS). His FPOS renewal is due in February. He submits a renewal on February 3. Verification is requested with a due date of February 23. Because his renewal was received timely, his FPOS coverage is maintained for March. Verification is received on February 19. Tom's income has decreased to below 100% FPL. Tom had a prior health care request on file, so he is now determined eligible for BadgerCare Plus with a new certification period starting April 1. Although FPOS was maintained through March, Tom is also enrolled in BadgerCare Plus for February and March. |
Eligibility must be retroactively determined in situations where health care coverage was maintained for one household member and, after the redetermination of eligibility, another household member that was previously not eligible for health care is newly eligible. Eligibility is determined back to the date the change was reported.
| Example 2 | John and his wife Julieta both applied for health care. Julieta was denied BadgerCare Plus due to being over income for her tax filing group size, but John opened for BadgerCare Plus. John is due for renewal in February. On February 3, the renewal is submitted. Verification is requested with a due date of February 23. John’s BadgerCare Plus coverage is maintained for March. Verification is received on February 19. An income decrease makes both John and Julieta eligible for BadgerCare Plus with a new certification period starting April 1. However, because the income reduction was reported and verified in February, Julieta’s eligibility for BadgerCare Plus is determined retroactively for February and March. |
This page last updated in Release Number: 25-04
Release Date: 12/10/2025
Effective Date: 12/10/2025
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.
Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.
Publication Number: P-10171