BadgerCare Plus Emergency Services

BadgerCare Plus Emergency Services provides limited health care coverage for people who are not eligible for BadgerCare Plus because of their immigration status but who need immediate care due to a medical emergency. A medical emergency is a medical problem that could put your health at serious risk if you do not get medical care right away. This does not include ongoing or chronic conditions.

Eligibility

You may be able to get BadgerCare Plus Emergency Services, if you:

  • Live in Wisconsin.
  • Are one of the following:
    • Younger than age 19
    • Age 18–25 and were in foster care or another out-of-home care placement when you turned 18
    • Pregnant
    • A parent or caretaker of a child younger than age 19 who lives with you
  • Have monthly income at or below the following:
    • For newborns through age 1, up to 306% of the federal poverty level
    • For children ages 1–5, up to 191% of the federal poverty level
    • For children ages 6–18, up to 156% of the federal poverty level
    • For youth age 18–25 in out-of-home care when they turned 18, any percent of the federal poverty level
    • For pregnant women, up to 306% of the federal poverty level
    • For parents and caretakers, up to 100% of the federal poverty level

Use the table below to see the dollar amount your income must be less than for you to be eligible for BadgerCare Plus Emergency Services. For example, if you are single parent with 4-year-old twins, you would have three people in your family, so your monthly income would need to be less than $3,395.03 for your children to be eligible and less than $1,777.50 for you to be eligible.

Family Size 100% FPL 156% FPL 191% FPL 306% FPL
1 $1,040.83 $1,623.69 $1,987.99 $3,184.94
2 $1,409.17 $2,198.31 $2,691.51 $4,312.06
3 $1,777.50 $2,722.90 $3,395.03 $5,439.15
4 $2,145.83 $3,347.49 $4,098.54 $6,566.24
5 $2,514.17 $3,922.11 $4,802.06 $7,693.36

These income limits are effective February 1, 2019. The income limits are based on federal guidelines, which may change each year.

Note: If you are age 65 or older, are blind, or have a disability, you may be eligible for Emergency Services Medicaid instead.

How to Apply

You can apply for BadgerCare Plus Emergency Services online, by phone, in person at your agency, or by mail.

Your agency will ask you for the dates of your emergency. You may have the doctor who treated you fill out and submit the Certification of Emergency for Non-U.S. Citizens form, F-01162, to help document this, but it is not required. Your doctor can call Provider Services at 800-947-9627 for help.

Enrollment Dates

BadgerCare Plus Emergency Services coverage begins on the first day you get medical care and ends when your condition is no longer an emergency. Because of this, you will not get a ForwardHealth card.

If you are pregnant, you may be able to enroll in the BadgerCare Plus Prenatal Plan instead. This program covers routine doctor visits and hospital care related to pregnancy as well as labor and delivery. However, if you are not able to get benefits through the BadgerCare Plus Prenatal Plan, your labor and delivery costs may be covered by BadgerCare Plus Emergency Services. You can apply for BadgerCare Plus Emergency Services up to one month before your due date. If you are eligible, you will be enrolled until the end of the month in which the 60th day occurs following the end of your pregnancy.

Covered Services

BadgerCare Plus Emergency Services covers only the medical care needed to treat your medical emergency. Being enrolled in BadgerCare Plus Emergency Services does not mean that BadgerCare Plus Emergency Services will cover all the care you get. If the care you get is not for a medical emergency, you will have to pay for it.

Example: Edgar had appendicitis and had to have his appendix removed. This was considered a medical emergency. Edgar applied for and was determined eligible for BadgerCare Plus Emergency Services. BadgerCare Plus Emergency Services covered the medical care needed to treat his appendicitis. A couple weeks later, Edgar went to his doctor for a routine checkup. Since this checkup was not a medical emergency, BadgerCare Plus Emergency Services did not cover it.

If you are pregnant, talk with your doctor about the care that will be covered under BadgerCare Plus Emergency Services.

Confidentiality

You do not have to provide a Social Security number to be eligible for BadgerCare Plus Emergency Services. Any information you do provide will not be shared with U.S. Citizenship and Immigration Services (USCIS).

Your Right to a Fair Hearing

If you disagree with a decision made about your eligibility or benefits, you can ask for a fair hearing. A fair hearing gives you the chance to tell why you think there has been a wrong decision about your eligibility or benefits. At the hearing, a hearing officer will hear from you and your agency to find out if the decision about your eligibility or benefits was right or wrong. You can bring a friend, family member, or attorney with you to the hearing if you would like.

You can ask for a hearing using a letter or a Request for Fair Hearing form.

Fax your letter or the form to 608-264-9885, or mail your letter or the form to:

Division of Hearings and Appeals
PO Box 7875
Madison, WI 53707-7875

You can also get free legal help. To learn more about free legal help, call Legal Action of Wisconsin at 888-278-0633 or Wisconsin Judicare Inc. at 800-472-1638.

 

Contact Information and Resources

  • If you need help applying or have questions about your eligibility, contact your agency.
  • If you have questions about services covered by BadgerCare Plus Emergency Services, call Member Services at 800-362-3002, Monday through Friday, from 8:00 a.m. to 6:00 p.m.
Last Revised: May 13, 2019