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Frequently Asked Questions About 2014 BadgerCare Plus Policy Changes

As of April 1, 2014, all Wisconsin residents will have access to affordable health insurance. Some individuals and families will get health care through Wisconsin's public health care program, BadgerCare Plus, while others will purchase it through the private market, their employer, or through the federal Health Insurance Marketplace.

If you have a question about the 2014 BadgerCare Plus Policy Changes, please review the questions and answers on this page to see if your question has already been answered. If you don't see an answer to your question, send it to dhshealthcare@dhs.wisconsin.gov so it can be answered and added to this page.

BadgerCare Plus Eligibility BadgerCare Plus Program Rules Modified Adjusted Gross Income (MAGI) Questions Effect of New BadgerCare Plus Rules on Other Programs
BadgerCare Plus Waiver Applying for Health Care BadgerCare Plus Outreach Marketplace Questions

BadgerCare Plus Eligibility

Please Note: If you have case-specific questions on behalf of an individual or family, you should contact the local agency. Only income maintenance agencies are able to determine eligibility. In addition, the health care application (at HealthCare.gov or through BadgerCare Plus) will ask all relevant questions and the agency processing the application will determine the proper household size and income calculation. Each applicant’s situation will be unique, so it is important that individuals file an application to receive the appropriate health care determination.

If a family applies through the Marketplace and the adults’ household income is above 100% FPL, would the child’s application be sent to BadgerCare Plus, or will the whole family stay in the Marketplace?

As of April 1, 2014, the following people are able to enroll in BadgerCare Plus:

If a family with household income between 100% and 300% FPL submits an application for health insurance through the Marketplace, the adults in the household would purchase their health insurance through the Marketplace while the applications for the children will be transferred to BadgerCare Plus for enrollment. Please see Letter 10 for additional information that was mailed to individuals who applied for health care at the Marketplace and were determined eligible for BadgerCare Plus. (Updated 12/20/13)

If a single parent works and has income over the 200% of the Federal Poverty Level (FPL), can the parent enroll their child for BadgerCare Plus and buy insurance for themselves through their employer or the Marketplace? Or does the individual have to buy insurance from the employer for the both of them?

If the parent has employer-sponsored health insurance but wants to be covered under a private health insurance plan offered through the Marketplace, he or she must have the employer complete the Employer Coverage Tool Form to help figure out if the employer-sponsored health insurance is considered affordable according to the Marketplace.

If a parent decides to apply at the Marketplace, he or she will be notified if the child is eligible for BadgerCare Plus when the application is completed and assessed for a health insurance plan. If the child is found eligible for BadgerCare Plus, the Marketplace will send their information to DHS so the child can be enrolled in BadgerCare Plus. The parent does not need to purchase a Marketplace plan for that child. Keep in mind that the child may still be subject to the BadgerCare Plus health coverage and access tests if the parent has employer-sponsored health insurance that offers coverage for families. For more information on the BadgerCare Plus health care coverage rules, please see the ForwardHealth Enrollment and Benefits Handbook. (Updated 12/20/13)

Do all current BadgerCare Plus Core Plan and Basic Plan members have to re-apply?

Current BadgerCare Plus Core Plan members with income at or below 100% FPL will automatically transition into BadgerCare Plus Standard Plan for coverage as of April 1, 2014. Those BadgerCare Plus Core Plan members above 100% FPL can apply for and purchase private health insurance through the Marketplace at HealthCare.gov or by calling 1-800-318-2596 (TTY: 1-855-889-4325). To avoid a coverage gap they must apply and pay their first premium by March 15, 2014 for April 1, 2014 coverage.

Basic Plan members should apply for health care benefits through the Marketplace. When they finish their application at the Marketplace, the Marketplace will let then know if they will be enrolled in BadgerCare Plus or if they should purchase private health insurance. If they will be enrolled in BadgerCare Plus, their coverage will begin April 1, 2014. If they should purchase private health insurance, the Marketplace will give them information about the health care plan options that are available to them, what those plans cost, and if they can get any help paying for your private health insurance. The health insurance that individuals purchase through the Marketplace can begin as soon as January 1, 2014. However, their health insurance will not begin until they choose their plan and pay their first monthly premium by the date given by the health plan.

Please Note: The Marketplace Open Enrollment period goes through March 31, 2014. (Updated 12/20/13)

Can childless adults apply for BadgerCare Plus coverage through the ACCESS online application tool right now?

Wisconsin’s online ACCESS application tool is not currently accepting BadgerCare Plus applications for adults between the ages of 19 and 64 who are not disabled, blind, pregnant or living with and caring for a child under age 19. ACCESS will be available for childless adults starting February 3, 2014. (Updated 12/20/13)

Under the new BadgerCare Plus rules, can an adult living with dependent children still qualify for BadgerCare Plus even if he or she is on Medicare?

Parents and caretakers who are getting Medicare can still qualify for BadgerCare Plus and have dual eligibility under both programs if they meet all the BadgerCare Plus rules, including having an income at or below 100% FPL. Adults without dependent children will not be eligible for BadgerCare Plus if they are also getting Medicare. (Updated 12/20/13)

Will the changes to the BadgerCare Plus program affect documented or undocumented immigrants applying for Emergency Services?

Yes. Effective April 1, 2014, the income limit for parents and caretakers who are not pregnant applying for Emergency Services is 100% FPL. Adult immigrants without dependent children will be ineligible for Emergency Services. (Updated 12/20/13)

Will pregnant inmates or non-qualifying pregnant immigrants who meet the new BadgerCare Plus rules be enrolled in the Standard Plan as of April 1, 2014?

Yes. Effective April 1, 2014, all pregnant women enrolled in BadgerCare Plus, including pregnant inmates and non-qualifying pregnant immigrants on the BadgerCare Plus Prenatal Program, will be enrolled in the BadgerCare Plus Standard Plan. (Updated 12/20/13)

Can you please provide more details about the new requirement that a pregnancy test is not needed for BadgerCare Plus in 2014.

Beginning January 1, 2014, verification of pregnancy will no longer be required for BadgerCare Plus enrollment. (Updated 12/20/13)

Will newborns be considered “Continuously Eligible Newborns” if their mother was enrolled in the BadgerCare Plus Standard Plan as of April 1, 2014?

There are no changes to the policies around Continuously Eligible Newborns. If the mother is enrolled in BadgerCare Plus as of April 1, 2014, her newborn will be considered a Continuously Eligible Newborn and will also be covered under the BadgerCare Plus Standard Plan, unless the mother is incarcerated and delivers the child while she is incarcerated. (Updated 12/20/13)

Are adults on BadgerCare Plus obligated to enroll into an employer-sponsored insurance plan?

For adults who are interested in applying for BadgerCare Plus, as of April 1, 2014 there will no longer be a health insurance access test, but they must meet all other BadgerCare Plus requirements. However, some children may still need to meet the BadgerCare Plus health insurance access test depending on their household income and the health insurance coverage. (Updated 12/20/13)

BadgerCare Plus Program Rules

Will the BadgerCare Plus Benchmark, Core and Basic Programs end on December 31, 2013?

No. Due to changes in state law, the BadgerCare Plus Benchmark Plan, BadgerCare Plus Core Plan, and BadgerCare Plus Basic Plan will continue to be available to current enrollees until April 1, 2014. They were originally going to end on December 31, 2013 however, because of difficulties with HealthCare.gov, Governor Walker called for a special session of the Legislature to take up Legislation that would allow individuals currently enrolled in BadgerCare Plus more time to enroll in a health care plan through the federal health insurance Marketplace. On December 20, 2013, Governor Walker signed Special Session Assembly Bill 1 into law. This bill allows individuals currently enrolled in BadgerCare Plus who do not meet the new program rules more time to purchase private health insurance through the federal health insurance Marketplace. As a result, most of the BadgerCare Plus changes that were slated to be implemented on January 1, 2014 are not scheduled to take effect until April 1, 2014. Members currently enrolled in the BadgerCare Plus Benchmark Plan and Core Plan who meet the new BadgerCare Plus rules will be enrolled in the BadgerCare Plus Standard Plan as of April 1, 2014. DHS will contact current members who are affected by the change in program rules in early March. (Updated 12/20/13)

Will all members on BadgerCare Plus be required to pay a premium?

No. Beginning April 1, 2014, the following members will be required to pay a monthly premium:

  • Parents and Caretaker Relatives of a dependent child under age 19 who are on a BadgerCare Plus Extension with income above 100% FPL.
  • Children with household income between 200% and 300% FPL, except for children under age one or children who are tribal members. (Updated 12/20/13)

When should BadgerCare Plus parents and caretaker relatives and Core Plan members stop paying their monthly premiums?

BadgerCare Plus parents and caretaker relatives and Core Plan members, who owe a premium must continue to pay any monthly premiums that they owe. They must continue to pay until they receive a letter stating that they continue to be eligible but no longer have a premium, or until they get a letter saying that they are no longer eligible for BadgerCare Plus. (Updated 12/20/13)

If a BadgerCare Plus Core Plan member is enrolled in a BadgerCare Plus Core Plan HMO as of April 1, 2014, will that former Core member be covered by BadgerCare Plus on a Fee-For-Service basis for the new BadgerCare Plus Standard coverage?

Benchmark Plan and Core Plan members who continue to meet the BadgerCare Plus rules and are being transitioned to the Standard Plan will continue to receive their care through an HMO if they live in an area that has HMO enrollment. If a BadgerCare Plus member has a question or concern about their HMO enrollment, they can reach the HMO Enrollment Specialist by calling 1-800-291-2002. (Updated 12/20/13)

What HMOs will serve BadgerCare Plus members in 2014?

DHS is currently working on HMO contracts for 2014, including finalizing the list of HMOs that will be serving BadgerCare Plus members. (Updated 12/20/13)

With the upcoming changes to BadgerCare Plus enrollment, after April 1, 2014, will BadgerCare Plus Standard Plan members be required to pay a copayment based on income?

Copayments for the Standard Plan are between $0.50 and $3.00 depending on the services. Members may be required to pay more than one copay if they get more than one service.

There are, however, copayment exemptions for certain BadgerCare Plus members. Health care providers are prohibited from collecting payments from the following BadgerCare Plus members:

  • American Indians or Alaskan Natives, regardless of age or income level, when they receive items and services either directly from an Indian health care provider or through referral under contract health services.
  • Children who are American Indian or Alaska Natives who are enrolled in BadgerCare Plus.
  • Terminally ill individuals receiving hospice care.
  • Nursing home residents.
  • Children in the following categories:
    1.  Children in foster care, regardless of age.
    2.  Children in adoption assistance, regardless of age.
    3.  Children in the Katie Beckett program, regardless of age.
    4.  Children under age one with income up to 150% FPL.
    5.  Children ages 1 through 5 with income up to 185% FPL.
    6.  Children ages 6 through 18 years of age with incomes at or below 133% FPL. (Updated 12/20/13)

Will people applying for BadgerCare Plus in 2014 be able to backdate their eligibility?

Members may be able to backdate their BadgerCare Plus enrollment for up to three months prior to the month of their application if they meet the any of the following:

  • Adults with income at or below 100% FPL. Note that BadgerCare Plus Standard Plan coverage for adults with no dependent children living in the home cannot begin earlier than April 1, 2014.
  • A pregnant woman, unless she is in the BadgerCare Plus Prenatal Program.
  • Some children can get backdated coverage:
    1.  Infants less than 1 year old may get backdated coverage for any of the months that their family income was at or below 300% FPL.
    2.  Children ages 1 through 5 may get backdated coverage for any of the months that their family income was at or below 185% FPL.
    3.  Children ages 6 through 18 may get backdated coverage for any of the months in which their family income was at or below 150% FPL. (Updated 12/20/13)

Can you explain more about the Transitional Medical Assistance or Extensions?

If a BadgerCare Plus parent, caretaker or pregnant woman has an increase in earnings or child/spousal support that puts them over 100% FPL, they will go into a four month period of continuous enrollment in BadgerCare Plus. In most cases, their children will also stay enrolled for this period. However, Congress has proposed extending the length of these extensions to 12 months, but just for those who have an increase in earnings. If that proposal is included in the federal budget deal, the length of the continuous enrollment will be 12 months. (Updated 12/20/13)

Can you explain how the restrictive re-enrollment period (RRP) will work under the new policy changes?

If a BadgerCare Plus member does not pay their required monthly premium, they will be placed in a restrictive re-enrollment period (RRP). A restrictive re-enrollment period is the period of time an individual is not eligible for BadgerCare Plus due to non-payment of a premium.

Beginning April 1, 2014, there are two groups subject to premiums and therefore to restrictive re-enrollment periods:

  • Non-exempt children ages 1 to 18 with incomes over 200% of the Federal Poverty Level (FPL).
  • BadgerCare Plus parents or caretakers who have an increase in earnings or spousal support that puts their income over 100% FPL and who receive a period of continuous enrollment in BadgerCare Plus as a result. This is called an extension, and is also known as Transitional Medical Assistance.

Both of these groups will be subject to a three month RRP for failure to pay a premium. At any time during the three month RRP, however, the unpaid premium(s) can be paid and the member can re-enroll in BadgerCare Plus. At the end of the three month RRP, the member can re-enroll without paying their unpaid premiums. (Updated 12/20/13)

Modified Gross Income (MAGI) Questions

Please note: The Income Maintenance (IM) agency will determine which income is counted for MAGI purposes. If you have questions about whether income is counted or how the MAGI rules will apply to a specific case, you could contact the IM agency.

How are household composition and income determined and will this be the same for BadgerCare Plus as it is for the Marketplace?

BadgerCare Plus eligibility determinations will use Modified Adjusted Gross Income (MAGI) rules. MAGI rules are based on the concept of an individual’s tax household, not necessarily on the physical household or family relationships. This methodology is designed to align with the MAGI rules used in the Marketplace.

Individuals who meet one of the exceptions to the MAGI tax filing rules or who are not tax filers or tax dependents will have their eligibility determined using relationship rules.

For more information on MAGI, view the partner trainings. (Updated 12/20/13)

Is Supplemental Security Income (SSI) no longer counted for parents or children?

Currently, Supplemental Security Income (SSI) is not counted as income for anyone applying for BadgerCare Plus and it will not be counted as income in 2014 either. (Updated 12/20/13)

Will child support be counted as income under MAGI ?

No, while it is currently counted as income, under the MAGI rules it will no longer be counted. (Updated 12/20/13)

Are Social Security Surviving Child Benefits counted towards household income for an adult when determining eligibility for BadgerCare Plus under Modified Adjusted Gross Income (MAGI) rules?

Although Social Security benefits are not taxable, under MAGI rules they must be counted as income. However, Social Security Benefits are not considered when determining if a child or tax dependent is “expected to be required” to file a tax return for the current year, which means that in most cases, a child’s Social Security benefits will not be counted. (Updated 12/20/13)

Will Family Planning Only Services (FPOS) applicants be counted as a group of one under MAGI rules, even if they are married?

Yes, for individuals whose eligibility for FPOS is determined under MAGI rules, the applicant’s group size will always be one. (Updated 12/20/13)

Effect of New BadgerCare Plus Rules on Other Programs

Will the new rules for BadgerCare Plus affect FoodShare members who are receiving both BadgerCare Plus and FoodShare benefits?

The new rules for BadgerCare Plus will not affect FoodShare. (Updated 12/20/13)

What will happen to the Medicaid Purchase Plan (MAPP)?

There are no changes to MAPP. (Updated 12/20/13)

Are Family Planning Only Services going to change?

Not at this time. After April 1, 2014, a few new income counting rules will apply the next time members renew their benefits. Only the member’s own income will count towards their Family Planning Only Services benefit. Because their group size will be one, we will not ask any questions about tax filing. (Updated 12/20/13)

BadgerCare Plus Waiver

What is the timeline for DHS to be informed regarding the outcome of the BadgerCare Plus Demonstration Waiver?

The Department continues discussions with the Centers for Medicare and Medicaid Services (CMS) on the new BadgerCare Plus waiver. (Updated 12/20/13)

Applying for Health Care

If an adult with no dependent children is under 100% of the Federal Poverty Level, should he or she apply at the Marketplace as soon as possible or wait until ACCESS accepting applications for BadgerCare Plus for adults with no dependent children?

An adult with no dependent children can apply for health care benefits through the Marketplace. The Marketplace will let the member know if he or she will be enrolled in BadgerCare Plus or that his or her application has been transferred to the State for coverage starting April 1, 2014. If the member has income at or below 100% FPL, he or she can choose to wait to apply on ACCESS for BadgerCare Plus. Adults with no dependent children living with them can begin applying for BadgerCare Plus online at ACCESS.wi.gov as of February 3, 2014. (Updated 12/20/13)

When can Adults with no dependent children, otherwise known as Childless Adults, under 100% FPL start to apply on ACCESS?

February 3, 2014. In the meantime, they can apply through the Marketplace at Healthcare.gov at any time. (Updated 12/20/13)

Can applications for child care, Family Planning Only Services, and Food Share still be completed on ACCESS?

Wisconsin individuals and families can still use ACCESS to apply online for Child Care, Family Planning Only Services, and FoodShare. They will also be able to continue applying for these programs online after the new BadgerCare Plus policies are effective. (Updated 12/20/13)

Will Express Enrollment still be available after March 31, 2014?

Yes, express enrollment, also known as presumptive eligibility, will still be available for qualifying children and pregnant women after March 31, 2014. (Updated 12/20/13)

Will there be any changes to the Express Enrollment Process for pregnant women and children after March 31, 2014?

In general, the Express Enrollment process for pregnant women and children will not change. However, a few policy changes will take effect February 1, 2014 and will be reflected in the online express enrollment tool available on ACCESS at that time. These include Express Enrollment eligibility for legal residents as well as citizens, limiting pregnant women to one period of eligibility under Express Enrollment per pregnancy, and no longer requiring verification of pregnancy for pregnant women. (Updated 12/20/13)

BadgerCare Plus Outreach

How many letters were sent out to Wisconsin residents regarding Health Care Options in 2014?

View the list of letters that were sent to BadgerCare Plus members and individuals on the BadgerCare Plus Core Plan Waitlist.

Below are the numbers of letters that were sent out:

  • Letter 1: 56,246 letters were sent to 77,472 individual members
  • Letter 1A: TBD – will have updated mailing numbers by 12/31/13
  • Letter 2: 11,431 letters were sent to 14,932 individual members
  • Letter 3: 163,808 individuals
  • Letter 3A: 163,808 individuals
  • Letter 4: 1,222 individuals
  • Letter 4A: 1,222 individuals
  • Letter 9: 56,246 letters were sent to 77,472 individual members
  • Letter 10: TBD – will have updated mailing numbers by 12/31/13 (Updated 12/20/13)

How will Benchmark and Core Plan members know they are transitioning to the Standard Plan?

Benchmark Plan and Core Plan members who continue to meet the BadgerCare Plus rules and are being transitioned to the Standard Plan will receive two mailings. A letter about your enrollment and a ForwardHealth Member Update will be mailed by the end of March regarding this change. The ForwardHealth Member Update will explain the coverage for those enrolled in the BadgerCare Plus Standard Plan. (Updated 12/20/13)

What outreach is being done to educate members about these changes and the need of some members to transition to the Marketplace?

The Department sent out several mailings notifying our current members and individuals on the BadgerCare Plus Core Plan Wait list about the BadgerCare Plus changes. Additional mailings will be sent out in late-December and in early 2014. Generic versions of these letters have been posted to the Department's website. Please note: the letters sent in September, October and November were mailed before the delay was announced; therefore, the letters include January 1, 2014 as the effective date of the changes.

In addition, the Department will be offered a series of taped webcasts and in-person trainings community partners, health care providers, public health departments and other interested stakeholders about the 2014 BadgerCare Plus Policy Changes in September, October and November 2013. Due to the delay in implementation of the 2014 BadgerCare Plus policy changes, the partner materials available at dhs.wisconsin.gov/health-care/training/index.htm are currently out-of-date. While the policies being implemented remain the same, the implementation dates contained within the videos and presentations are out-of-date. Updated information will be available in the near future. A webcast training that will be recorded and available online regarding this series of mailings. The same is true for the BadgerCare Plus handbook. While the policies outlined in the handbook are still correct, the implementation dates will be updated over the next several weeks.

These trainings for community partners tie into the Department’s overall strategy of working with the Regional Enrollment Networks (RENs) to assist Wisconsin residents with enrolling in the appropriate public or private health care coverage. (Updated 12/20/13)

What outreach will be done to families with children on BadgerCare Plus that are currently over 300% FPL?

All BadgerCare Plus households that may be affected by policy changes should have received an informational mailing in late September. The informational mailings refer households with members who now need to purchase private health insurance through the Marketplace with information about how to contact the Marketplace. Any households that have members affected by changes will receive another letter in early March. (Updated 12/20/13)

What letter is being sent to BadgerCare Plus Standard Plan, Benchmark Plan, and Core Plan members who will be losing eligibility after March 31, 2014?

Members who are losing eligibility after March 31, 2014 will receive an enrollment letter (also called a Notice of Decision). They should receive this letter in mid-February to let them know that their benefits will be ending on March 31, 2014 and to remind them to apply at the Marketplace for health insurance (or, if they provided MAGI information via the form in letter 1A, we will let them know that we have transferred their application to the Marketplace). Most of these members would have received a letter indicating changes to the BadgerCare Plus program in late September or early October.

A letter was sent in September to allow current members to report any changes that may affect their eligibility and keep them enrolled in BadgerCare Plus as well as allow members whose income is greater than 100% FPL as much time as possible to research their health care options and apply for coverage through the Marketplace. Individuals who received letters that indicate their income may place them above the limits for BadgerCare Plus are encouraged to visit www.healthcare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325). If people have questions about these letters, they are encouraged to contact the local agency listed on the top of their letter. (Updated 12/20/13)

For the outbound telephone call campaign coordinated by DHS, will phone calls be made to BadgerCare Plus fee-for-service enrollees only or will phone calls also be made to BadgerCare Plus members who are enrolled in HMOs at the time of the call?

The outbound telephone call campaign was designed as another method of outreach to tell members about changes to the BadgerCare Plus program in 2014. Phone calls will be made to the following BadgerCare Plus members, whether they are enrolled in an HMO or not:

  • BadgerCare Plus members who will need to purchase private health insurance through the Marketplace,
  • Basic Plan members.
  • Individuals on the Core Plan Waitlist.

Please note that when DHS contacts these members they may ask for the member’s month of birth, but will not ask for any personally identifiable information or protected health information. (Updated 12/20/13)

Where should we go to look for updates and member materials?

Please visit badgercareplus.org/ for information about BadgerCare Plus programs and healthcare.gov for information about the Marketplace. (Updated 12/20/13)

When will the DHS website have updated forms/publications available?

Updated form, publications, trainings, member fact sheets, and other information in early 2014. (Updated 12/20/13)

Marketplace Outreach

View Marketplace partner information and resources

When does open enrollment end?

The Marketplace Open Enrollment period goes through March 31, 2014. (Updated 12/20/13)

Will people still get to keep their same doctor once they are enrolled in the Marketplace, under any insurance that they pick?

For those individuals that have purchase private health insurance, each health insurance plan will have its own provider networks. Whether or not the individual’s previous provider is within the private health insurance plan's network will depend on the plan's provider network and the individual's preferred doctor. Individuals and families can learn about the plans in their area, including costs and the provider network, by going to HealthCare.gov/find-premium-estimates. (Updated 12/20/13)

How is “affordable” defined for the employer provided insurance in the Marketplace?

See the Marketplace website for their definition of “affordable.” (Updated 12/20/13)

What process will Wisconsin use for the Marketplace related appeals?

The Marketplace will be handling all Marketplace related appeals. For more information, go to the Marketplace. All eligibility determinations made by Wisconsin Income Maintenance (IM) agencies will continue to be handled by Wisconsin Division of Hearings and Appeals. (Updated 12/20/13)

Last Revised: June 19, 2014