40.2 Presumptive Eligibility

40.2.1 Introduction
1. 40.2.1.1 Qualified Entities
2. 40.2.1.2 Coverage Period
40.2.2 Eligibility
40.2.3 Express Enrollment in ACCESS

40.2.1 Introduction

Presumptive eligibility for Family Planning Only Services provides family planning and family planning-related services only (see Section 32.1 Introduction).

40.2.1.1 Qualified Entities

Qualified entities that can be certified by ForwardHealth to make presumptive eligibility determinations for Family Planning Only Services include:

Medicaid providers
Qualified hospitals

For more information about qualified entities, see Section 32.1.2 Qualified Entities.

40.2.1.2 Coverage Period

For information about when coverage begins and ends, early terminations, and automatic extensions, see Section 32.1.3 Coverage Period.

40.2.2 Eligibility

A person can get temporary enrollment for Family Planning Only Services if they meet all of the following financial and nonfinancial criteria:

Be of child bearing or reproductive age.
Be a Wisconsin resident.
Have income at or below 306% of the FPLFederal Poverty Level. For information about income disregards under MAGIModified Adjusted Gross Income. MAGI rules are used to determine BadgerCare Plus eligibility for new applicants beginning in 2014 and for existing members as of March 31, 2014, or their next regularly scheduled renewal, whichever is later. MAGI rules are based on tax relationships and family relationships, and they consider taxable income and whether children and tax dependents are required to file. rules, see Section 16.1.2 Income Under Modified Adjusted Gross Income Rules.
Meet one of the following:
- For people age 18 and younger:
  - Be a U.S. citizen
  - Be lawfully present in the U.S. (no requirement for the amount of time the person is lawfully present in the U.S.)
- For people age 19 and older:
  - Be a U.S. citizen
  - Be lawfully residing in the U.S. under one of the eligible immigration statuses or situations listed in Section 4.3.8 Immigration Status Chart

Is not currently receiving Family Planning Only Services, BadgerCare Plus, or other full benefit Medicaid.

40.2.3 Express Enrollment in ACCESS

Refer to ACCESS Handbook, Chapter 12 ACCESS for Partners and Providers for information on making presumptive eligibility determinations for Family Planning Only Services using the Express Enrollment process in ACCESS.

This page last updated in Release Number: 17-01
Release Date: 04/11/2017
Effective Date: 09/24/2016

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