State of Wisconsin Department of Health Services

Release 25-02 April 9, 2025

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32.2 Eligibility

32.2.1 Current Enrollment in Ongoing Health Care Benefits

An applicant is not eligible for temporary enrollment if they are already receiving ongoing health care benefits. Table 1 describes the situations where this applies.

Table 1: Current Enrollment in Ongoing Health Care or Family Planning Only Services Coverage
Applicant is currently enrolled in:	Applicant is applying for temporary enrollment in BadgerCare Plus:	Applicant is applying for temporary enrollment in Family Planning Only Services:
BadgerCare Plus or other ongoing Medicaid coverage	Deny temporary enrollment	Deny temporary enrollment
Family Planning Only Services	Allow temporary enrollment*	Deny temporary enrollment

*If all other temporary enrollment criteria are met

32.2.2 Temporary Enrollment Within the Last 12 Months

An applicant may only be temporarily enrolled once in a rolling 12-month period, or once per pregnancy. The 12-month period starts the first day of the presumptive eligibility (PE) period.

Example 1

David is determined presumptively eligible for Family Planning Only Services (FPOS) on January 14. He cannot enroll again in presumptive eligibility for FPOS for 12 months after January 14.

Table 2 describes the situations where this applies.

Table 2: Temporary Enrollment Within the Last 12 Months
Applicant was temporarily enrolled in:	Applicant is applying for temporary enrollment in BadgerCare Plus (non-pregnant members):	Applicant is applying for temporary enrollment in BadgerCare Plus (pregnant members):	Applicant is applying for temporary enrollment in Family Planning Only Services:
BadgerCare Plus (non-pregnant members)	Deny temporary enrollment	Allow temporary enrollment*	Allow temporary enrollment*
BadgerCare Plus (pregnant members)	Deny temporary enrollment	Allow temporary enrollment* as long as the previous temporary enrollment was not for the same pregnancy	Allow temporary enrollment*
Family Planning Only Services	Allow temporary enrollment*	Allow temporary enrollment*	Deny temporary enrollment
No programs	Allow temporary enrollment*	Allow temporary enrollment*	Allow temporary enrollment*

*If all other temporary enrollment criteria are met

32.2.3 Temporary Enrollment in BadgerCare Plus

32.2.3.1 Children

A child may get temporary enrollment for BadgerCare Plus if they meet all of the following financial and non-financial criteria:

• Be age 18 or younger. Children younger than age 18 must apply with a parent or guardian unless the child is living independently.
• Be a U.S. citizen or lawfully present in the U.S. (there is no requirement for the amount of time the person is lawfully present in the US).
• Be a Wisconsin Resident
• Has household income that is at or below the FPLFederal Poverty Level for the child’s age:
  • Younger than age one: 306% of the FPL.
  • Age one through five: 191% of the FPL.
  • Age six through 18: 156% of the FPL.

Note	See Section 16.1.2 Income Under Modified Adjusted Gross Income Rules for additional information on MAGI income disregards.

32.2.3.2 Pregnant Members

An individual may get temporary enrollment for BadgerCare Plus as a pregnant member if they meet all of the following financial and nonfinancial criteria:

• Be pregnant. (Verification of pregnancy is not required.)
• Be a U.S. citizen or lawfully present in the U.S. (There is no requirement for the amount of time the person is lawfully present in the U.S.).
• Be a Wisconsin resident
• Has household income that is at or below 306% of the FPL.
• Has not been temporarily enrolled for BadgerCare Plus for Pregnant Women at any time during the current pregnancy.

Note	Temporary enrollment in BadgerCare Plus for pregnant members only covers ambulatory pregnancy-related care. An application for ongoing health care benefits is required for inpatient services, including the delivery.

32.2.3.3 Adults

An adult (parent, caretaker, and childless adult) may get temporary enrollment for BadgerCare Plus if they meet the following financial and non-financial criteria:

• Has assistance group income at or below 100% of the FPL.
• Is not currently receiving Medicare Part A or B (applies to childless adults only). This includes adults who are receiving Medicare Parts A or B due to a diagnosis of End Stage Renal Disease (ESRD).
• Meets one of the following:
  • Is a U.S. citizen
  • Has been lawfully residing in the U.S. for at least five years
  • Is lawfully residing in the U.S. and is a refugee or is seeking asylum
  • Is from Cuba or Haiti and is lawfully residing in the U.S.
  • Is lawfully residing in the U.S. under one of the eligible immigration statuses listed in Section 4.3.8 Immigration Status Chart.
• Be a Wisconsin resident

32.2.3.4 Former Foster Care Youth

A Former Foster Care Youth may get temporary enrollment for BadgerCare Plus if they meet all of the following nonfinancial criteria:

• Be age 18 through 25.
• Had been receiving Foster Care, subsidized guardianship, or court-ordered Kinship Care on the date that they turned 18. It does not matter what state they were residing in when they turned 18 years old.
• Meet citizenship or immigration criteria for the population above that applies to them.
• Be a Wisconsin resident

There is no income limit for Former Foster Care Youth.

32.2.3.5 Inmates

Qualified hospitals can make presumptive eligibility determinations for patients who are inmates of public correctional institutions (for example, county jails) as long as those patients are expected to remain in the hospital for 24 hours or more. The presumptive eligibility determination process for these patients is the same as for the populations listed above. Inmates of a state correctional facility are not eligible for temporary enrollment in BadgerCare Plus or Family Planning Only Services.

32.2.4 Temporary Enrollment in Family Planning Only Services

Refer to Section 40.2 Presumptive Eligibility for information.

32.2.5 Household Size

For presumptive eligibility for BadgerCare Plus, the household size must include all members of the household, even if they are not requesting presumptive eligibility and are not listed on the application. Household members include:

• Children under age 19. If the child is married, their spouse should also be included.
• The biological, adoptive, or stepparents living with the children under age 19.
• Spouses.
• Caretaker relatives.
• For a pregnant individual, the number of babies expected.

For presumptive eligibility for Family Planning Only Services, the household size can only be “1” regardless of whether the individual is under age 18, married and/or has children, so this field will be automatically filled with “1.”

32.2.6 Income

32.2.6.1 Monthly Earned Income

For presumptive eligibility for BadgerCare Plus, earned income from all household members listed in ACCESS Handbook, Section 12.4.5.1 Household Size should be reported even if they are not requesting presumptive eligibility and are not listed on the application.

For presumptive eligibility for Family Planning Only Services, only the earned income of the individual on the application should be reported.

Earned income is income resulting from performing a job or providing a service. Earned income includes commissions, tips, salaries, wages, and self-employment. To calculate the amount of the monthly earned income, the user must first determine how the employee is paid:

• Paid Hourly: If the employee is paid hourly, the user must multiply the number of hours worked per week by the amount of pay per hour and then multiply that amount by 4 to get the monthly income. The user should count monthly income before taxes are taken out but after any pre-tax deductions are taken out of the paycheck. Any overtime or weekend pay should also be counted.
• Paid a Salary: If the employee is paid a salary, the user must enter the monthly amount of the salary. If the salary is based on a yearly amount, the user should divide the yearly amount by 12 to determine the monthly amount. The user should count monthly income before taxes are taken out but after any pre-tax deductions are taken out of the paycheck.
• Tips and Commission: If the employee is paid in tips or commission, the user should count the average amount of tips or commission received monthly.

Note

Former Foster Care Youth are not subject to the income eligibility criteria. If an individual is a Former Foster Care Youth and is the only person in the household, the user should enter income amounts of $0. If an individual is a Former Foster Care Youth and is on the same presumptive eligibility for BadgerCare Plus application as other household members, the user must include the Former Foster Care Youth’s income since it must be considered when determining the eligibility of the other household members. The Former Foster Care Youth’s income will not be considered when determining the Former Foster Care Youth’s eligibility.

Self-employment Income: Self-employment income (income earned directly from one’s own business, rather than earned as an employee with a specified salary or wages from an employer) should be counted as monthly earned income. However, self-employment expenses (the monthly average of expenses) should be deducted from self-employment income to determine the net self-employment amount.

Student income: Income earned from work-study jobs should be counted as monthly earned income.

The following should not be counted as monthly earned income:

• Tax refunds, including Earned Income Tax Credits payments.
• Allowances.

32.2.6.2 Other Monthly Income

For presumptive eligibility for BadgerCare Plus, other monthly income from all household members listed in ACCESS Handbook, Section 12.4.5.1 Household Size, should be reported even if they are not requesting presumptive eligibility and are not listed on the application.

For presumptive eligibility for Family Planning Only Services, only the other monthly income of the individual on the application should be reported.

Other monthly income includes taxable income from a source other than a job or self-employment. For example:

• Social Security (gross amounts should be used).
• Unemployment.
• Pensions (only the taxable amount should be counted).
• Annuity payments (only the taxable amount should be counted).
• Insurance benefits.
• Payments received for the rental of rooms, apartments, dwelling units, buildings, or land (if not reported as self-employment income). Taxes and the expense of property maintenance may be deducted.
• Income from Tribal Per Capita payments from gaming revenue.

The following should not be counted as other monthly income:

• Supplemental Security Income (SSI).
• Student loans.
• Student financial aid including grants, scholarships, and fellowships.
• Child support income.
• Workers’ compensation.
• Veteran’s benefits.
• Reimbursement for expenses that the applicant has incurred or paid, except for reimbursement for normal household living expenses such as rent, clothing or food eaten at home.
• Foster care or subsidized adoption payments.
• Life insurance policy dividends.  
• Payments made by a third party directly to landlords or other vendors.
• Governmental (federal, state, or local) rent and housing subsidies, including payments made directly to the applicant for housing or utility costs (for example, U.S. Department of Housing and Urban Development (HUD) utility allowances).
• Nutrition-related benefits, such as FoodShare Wisconsin.

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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.

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