Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 103 - Eligibility › Section DHS 103.085 - Conditions for continuation of eligibility for BadgerCare Plus

Current through June 24, 2024
(1) PREMIUMS.
(a)
Authority
. Subject to s.
				49.471 (10) (b)
				2, Stats., and this section, a child under
				the age of 19 eligible for BadgerCare Plus may be required to pay a
				premium.
(b)
Applicability
.
1. A child
				under age 19 eligible for BadgerCare Plus with budgetable income at or below
				201% of the poverty line is not required to pay a premium toward the cost of
				the health care coverage.
2. Except
				as provided in subd. 3., 4., or 5., a child under age 19 eligible for
				BadgerCare Plus with budgetable income above 201% of the poverty line shall pay
				a premium toward the cost of the health care coverage.
3. A BadgerCare Plus applicant group does not
				owe a premium for the first month of BadgerCare Plus unless a member of the
				BadgerCare Plus fiscal test group was an MA recipient in the previous
				month.
4. A BadgerCare Plus
				applicant group does not owe a premium for the first month of BadgerCare Plus
				unless a member of the BadgerCare Plus fiscal test group was a BadgerCare Plus
				recipient in the previous 12 months.
5. A child under the age of 19 shall not be
				required to pay a premium if any of the following apply:
a. The child is a Native American or an
				Alaskan Native.
b. The child is
				under age 1.
c. The child is
				pregnant.
d. The child is eligible
				under s. 49.471 (4) (a)
				5, Stats.
e. The child is eligible under s.
				49.471 (4) (a)
				7, Stats.
f. The child is eligible under s.
				49.471 (7) (b)
				2, Stats.
(c)
Amounts
. A child
				eligible for BadgerCare Plus required under this subsection to pay a premium
				shall pay the amount indicated in the schedule provided in Table 103.085,
				except as provided under par. (cm). Income for each child's BadgerCare Plus
				fiscal test group shall be determined according to s.
				DHS
				103.07.
Table 103.085
BadgerCare Premium
								Schedule
Monthly Income as a Percentage
								of the Poverty Line
Monthly Premium
From
To
Above 201%
210.99%
$ 10
211%
220.99%
$ 10
221%
230.99%
$ 10
231%
240.99%
$ 15
241%
250.99%
$ 23
251%
260.99%
$ 34
261%
270.99%
$ 44
271%
280.99%
$ 55
281%
290.99%
$ 68
291%
300.99%
$ 82
301%
306%
$ 97.53
(cm)
Caps on premiums.
Families must pay either the combined
				premiums for all of the children required to pay or an amount equal to five
				percent of the family's countable monthly income, whichever is less.
(d)
Payment
.
1. All children otherwise eligible for
				BadgerCare Plus in a family who are required to pay a premium under this
				section shall pay the premium amount in full to the agency before the agency
				may certify the children's initial eligibility for BadgerCare Plus.
2. Premiums are due by the 10th of the month
				prior to the month for which the premium is required.
3. If no payment is received by the end of
				the month for which the premium is required, the department shall terminate the
				group's eligibility for BadgerCare, effective at the end of the
				month.
4. The department shall
				allow a variety of premium payment methods. A group may choose one of the
				following methods for premium payment:
a. Wage
				withholding.
b. Electronic funds
				transfer (EFT).
c. Direct payment
				by check or money order.
(e)
Refunds
. The department
				shall issue a refund for a premium which has been paid when the premium is for
				one of the following:
2. A month that the
				child's budgetable income drops to or below 200% of the poverty line and the
				change in income that brought the child's budgetable income to or below 200% of
				the poverty line was reported within 10 days of the date the change
				occurred.
3. A month which requires
				a lower premium amount due to a change in circumstances which was in effect for
				the entire month so long as the change was reported within 10 days of the date
				it occurred. In a case where the change was not reported within 10 days of the
				date it occurred, the effective date of the lower premium amount due is the
				first day of the month in which the change was reported.
(f)
Consequence of failure to pay
				BadgerCare premiums.
A child required to pay a premium shall be
				ineligible for re-enrollment for the period specified in sub. (3) when the
				group fails to pay its premium within the time specified in par. (d).