8.1 Pregnant Members

Note	This chapter does not apply to pregnant members in the BadgerCare Plus Prenatal Program.

A pregnant member who is enrolled in BadgerCare Plus stays eligible for both:

The duration of the pregnancy.
The postpartum period, which concludes at the end of the month 12 months after the end of the pregnancy.

The application does not need to be submitted prior to the end of the pregnancy, but the person must be eligible for BadgerCare Plus or Medicaid for one or more months in which they were pregnant in order for the member to remain enrolled as a pregnant member for the postpartum period. An application for Express Enrollment does not meet this application test.

Example 1

Laverne's pregnancy ended in September. She applies for BadgerCare Plus in October, and she requests one month of backdated eligibility. She is found eligible for BadgerCare Plus starting September 1. Since she was eligible for BadgerCare Plus during at least one month in which she was pregnant, she is eligible for the 12-month postpartum period.

A pregnant member with income over 306% of the Federal Poverty Level (FPL)Federal Poverty Level at the time of application when eligibility is first determined can become eligible for BadgerCare Plus by meeting a deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan. (see Section 17.2 Pregnant Members).

There are no premiums for pregnant members.

All pregnant members, except those eligible under the BadgerCare Plus Prenatal Program, may have their eligibility backdated according to backdating policy (see Section 25.8.2 Backdated Eligibility). If a person is determined to be eligible as a pregnant member for a backdated month, they remain eligible, even if they are over the income limit for any subsequent months, as long as they are still pregnant.

Example 2

Barb is pregnant and applied for BadgerCare Plus in December with a two-month backdate request. Barb is due in March. Her income was below 306% of the FPL for October, but over 306% for November, December, and ongoing. She met all of the other eligibility criteria. Since she was determined eligible as a pregnant member for the month of October, the subsequent increase in her income is ignored and she remains eligible for BadgerCare Plus through the 12th month after the end of the pregnancy.

Pregnant Children

When a pregnancy is reported for a child under age 19 on a case, they will have continuous coverage through at least the end of the 12-month postpartum period or the end of their 12-month continuous coverage period, whichever is later.

Example 3

Marita and her 16-year-old daughter Lupita have been enrolled in BadgerCare Plus since January 2026. In April 2026, they report that Lupita is pregnant with a due date of January 25, 2027. Lupita moves from BadgerCare Plus eligibility as a child to eligibility as a pregnant member effective May 1, 2026. Lupita's continuous coverage end date is updated to January 31, 2028, the end of the postpartum period. In December 2026, Marita completes a renewal and has a new certification period established from January 1, 2027, to December 31, 2027. Lupita delivers a baby January 13, 2027. The baby is enrolled in BadgerCare Plus as a continuously eligible newborn through January 31, 2028. Lupita remains enrolled in BadgerCare Plus as a pregnant member until the end of the postpartum period on January 31, 2028.

If a child under age 19 applies as a pregnant minor on their own case, and they are initially enrolled in BadgerCare Plus as a pregnant member, they will get their 12-month continuous coverage period as a pregnant member. If their 12-month postpartum coverage period ends before the 12-month continuous coverage period ends, the member will be tested for other benefits (for example, they may transition to coverage as a child or a parent/caretaker), but if they do not qualify for another category of health care, they will remain enrolled in BadgerCare Plus as a pregnant member for the rest of their 12-month continuous coverage period for children.

Example 4

Jordan is 17, pregnant, lives on their own, and is not claimed as a tax dependent. Jordan's pregnancy ended in March 2027. Jordan applied for BadgerCare Plus in May 2027 and requested two months of backdated coverage. Jordan is determined eligible for BadgerCare Plus as a pregnant member starting March 1, 2027. Jordan's postpartum coverage ends March 31, 2028. Because they are under age 19 and are applying on their own case, their 12-month continuous coverage period as a child lasts from May 1, 2027 to April 30, 2028. When Jordan's postpartum coverage ends March 31, 2028, they can transition to other benefits if they meet program rules, but otherwise, they will remain enrolled in BadgerCare Plus as a pregnant member through April 30, 2028.

If the pregnant child turns 19 during the pregnancy or postpartum period, they remain entitled to their continuous coverage as a pregnant member.

Example 5

Lynn and her children, Bailey and Taylor, are open for BadgerCare Plus. A pregnancy is reported for Taylor, and they are transitioned to BadgerCare Plus for a pregnant member as of September 2026. The pregnancy ends due to miscarriage on December 5, 2026. Taylor turns 19 on January 2, 2027. They remain eligible for BadgerCare Plus as a pregnant member for the rest of the 12-month postpartum period until December 31, 2027.

This page last updated in Release Number: 26-03
Release Date: 08/12/2026
Effective Date: 06/01/2026