17.8 Change in Income

Once the deductibleThe amount of health care expenses an insured person is required to incur before benefits are payable under a health insurance plan. has been met, changes in income do not affect the group’s eligibility for the remainder of the deductible period.

If there are income changes reported during the BadgerCare Plus deductible period but prior to meeting the deductible, recalculate the BadgerCare Plus deductible amount. Beginning July 1, 2020, the deductible amount will no longer be increased when an unmet deductible assistance group has an increase in income or a decrease in deductions, or when the group size decreases. Once a deductible period and deductible amount are established, the deductible amount will never increase during the same deductible period. Deductible amounts may be decreased due to changes in income, deductions, or group size. To determine the amount of a decreased deductible:

Add together the monthly excess income of the months of the BadgerCare Plus deductible period that have already gone by.
Subtract the income limit from the new monthly income. This will give the excess income for the month when the income changed.
Using prospective net income, find the excess income of the months in the deductible period after the month when income changed.
Add the results of #1, #2 and #3.

Example 1

Cicely, a pregnant woman with income over 300% FPL, applied for BadgerCare Plus in July. She had excess income of $20 a month. Her BadgerCare Plus deductible was $120. On October 8, she reports a pay decrease of $10 a month. The change is effective for November. The BadgerCare Plus deductible amount is recalculated by:

Adding together the excess income of months July through October. The result is $80.
Calculating her November excess income. The result is excess income of $10.
Prospective excess income for December is $10.
Cicely's new BadgerCare Plus deductible amount is: $80 + $10 + $10 = $100.

If the income change results in lower excess income in the month of change, the applicantA request for BadgerCare Plus coverage. The request must be on the Department's or Federally-facilitated Marketplace’s application, registration form or account transfer (from Federally-facilitated Marketplace) and must contain name, address, and a valid signature. The applicant must submit a signed and completed application form to complete the application process. can choose to:

Recalculate the current BadgerCare Plus deductible, or
Create a new deductible period.

Example 2

Mary, a pregnant woman, goes from full time to part time employment in the fourth month of her BadgerCare Plus deductible period. She still has excess income, but it is lower than in the previous three months. She can choose either to recalculate her BadgerCare Plus deductible to a lower amount or to start a new deductible period.

If she chooses to start a new deductible period, she will forfeit any eligibility she might have acquired in the previous deductible period if she had met the previous deductible.

If the income change results in no excess income the applicant has an additional choice:

Recalculate the deductible.
Create a new deductible period.
Begin eligibility immediately.

This page last updated in Release Number: 20-03
Release Date: 08/03/2020
Effective Date: 07/01/2020

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.

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