3. If the size of the MA group increases due to the addition of a child, that child is eligible for benefits during the rest of the spend–down period. An adult caretaker who enters the AFDC BadgerCare Plus −related or SSI−related MA group, except a woman who is medically verified as pregnant or a person who is SSI–related, is not eligible for benefits during the remainder of the spend–down period.
SECTION 97. DHS 103.085 (title), (1) (a), and (b) 1. to 4. are amended to read:
DHS 103.085 Conditions for continuation of eligibility for BadgerCare Plus. (1) PREMIUMS.
(a) Authority. Subject to s. 49.665 (5) 49.471 (10) (b) 2., Stats., and this section, a group child under the age of 19 eligible for BadgerCare Plus may be required to pay a premium. (b) Applicability. 1. A group child under age 19 eligible for BadgerCare Plus with budgetable income at or below 150% 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., or 4., or 5., a group child under age 19 eligible for BadgerCare Plus with budgetable income above 150% 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.
SECTION 98. DHS 103.085 (1) (b) 5. is created to read:
DHS 103.085 (1) (b) 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.
SECTION 99. DHS 103.085 (1)(c) and Table 103.085 are amended to read:
(c) Amounts. A group 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 sub. (cm). Income for each child’s BadgerCare Plus fiscal test group shall be determined according to s. DHS 103.07. BadgerCare Plus Premium Schedule |
Monthly Income as a Percentage of the Poverty Line | Monthly |
$ 1,000 Above 201% | $ 1,499.99 210.99% | $ 30 10 |
$ 1,500 211% | $ 1,999.99 220.99% | $ 45 10 |
$ 2,000 221% | $ 2,499.99 230.99% | $ 60 10 |
$ 2,500 231% | $ 2,999.99 240.99% | $ 75 15 |
$ 3,000 241% | $ 3,499.99 250.99% | $ 90 23 |
$ 3,500 251% | $ 3,999.99 260.99% | $ 105 34 |
$ 4,000 261% | $ 4,499.99 270.99% | $ 120 44 |
$ 4,500 271% | $ 4,999.99 280.99% | $ 135 55 |
$ 5,000 281% | $ 5,499.99 290.99% | $ 150 68 |
$ 5,500 291% | $ 5,999.99 300.99% | $ 165 82 |
$ 6,000 301% | $ 6,499.99 306% | $ 180 97.53 |
SECTION 100. DHS 103.085 (1) (cm) is created to read:
DHS 103.085 (1)(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.
SECTION 101. DHS 103.085 (1) (d) 1. is amended to read:
DHS 103.085 (1)(d) Payment. 1. A group All children otherwise eligible for BadgerCare Plus that is 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 group’s children’s initial eligibility for BadgerCare Plus.
SECTION 102. DHS 103.085 (1) (d) 5. is repealed.
SECTION 103. DHS 103.085 (1) (e) (intro.) is amended to read:
DHS 103.085 (1)(e) Refunds. The department shall issue a refund for a premium which has been paid in advance when the premium is for one of the following:
SECTION 104. DHS 103.085 (1) (e) 1. is repealed.
SECTION 105. DHS 103.085 (1) (e) 2. and (f) amended to read:
DHS 103.085 (1) (e) 2. A month that the group’s child’s budgetable income drops to or below 150% 200% of the poverty line and the change in income that brought the group’s child’s budgetable income to or below 150% 200% of the poverty line was reported within 10 days of the date the change occurred.
DHS 103.085 (1)(f) Consequence of failure to pay BadgerCare Plus premiums. A group 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).
SECTION 106. DHS 103.085 (2) is repealed.
SECTION 107. DHS 103.085 (3) (a) is amended to read:
(3) RE−ENROLLMENT RESTRICTION. (a) Period of ineligibility. A BadgerCare Plus group that fails to make a premium payment under sub. (1) or quits BadgerCare under sub. (2) is not eligible for BadgerCare Plus for a period of at least 6 3 consecutive calendar months following the date that BadgerCare Plus eligibility ends, unless one of the circumstances in par. (b) applies. Eligibility is restored as described in par. (c). After 6 3 calendar months, the group child shall be eligible for BadgerCare Plus only if all past premiums due are paid in full or 12 calendar months have passed after the expiration of BadgerCare eligibility, whichever is sooner otherwise eligible.
SECTION 108. DHS 103.085 (3) (b) (intro.) is amended to read:
DHS 103.085 (3) (b) The restriction on re-enrollment under this section does not apply if the failure to pay premiums was due to a circumstance beyond the group's control, provided that all past due premiums have been paid in full. A circumstance beyond the group's control includes for any of the following reasons:
SECTION 109. DHS 103.085 (3) (b) 1. to 3. are repealed and recreated to read:
DHS 103.085 (3) (b) 1. The failure to pay premiums was due to a circumstance beyond the group’s control, provided that all past due premiums have been paid in full. A circumstance beyond the group’s control includes any of the following:
a. A problem with an electronic funds transfer from a bank account to the BadgerCare Plus program.
b. A problem with an employer’s wage withholding.
c. An administrative error in processing the premium.
d. A fair hearing decision.
2. The child’s income decreases to at or below 201% of the poverty line.
3. Payment is received in full for all owed premiums before the end of the three-month restrictive re-enrollment period.
SECTION 110. DHS 103.085 (3) (c) 1. is amended to read:
DHS 103.085 (3)(c) 1. For a BadgerCare group child with a reason under par. (b) 1. for the re−enrollment restriction not to apply, BadgerCare Plus eligibility shall be restored for any months that the group had been closed during the restriction period, provided that payment of any outstanding premiums owed is made and the group child was otherwise eligible for BadgerCare Plus in those months.
SECTION 111 DHS 103.085 (3) (c) 2. is repealed and recreated to read:
DHS 103.085 (3)(c) 2. For a child with a reason under par. (b) 3. for the re−enrollment restriction not to apply, BadgerCare Plus eligibility shall be restored for any calendar months that the child’s BadgerCare Plus fiscal test group’s income was at or below 201% of the poverty line and the child was otherwise eligible for BadgerCare Plus in those months.
SECTION 112. DHS 103.085 (3) (c) 3. is created to read:
DHS 103.085 (3)(c) 3. For a child with a reason under par. (b) 4. for the re−enrollment restriction not to apply, BadgerCare Plus eligibility shall be restored for all months that the child had been ineligible during the restriction period, provided that payment of any outstanding premiums owed is made and the child is otherwise eligible for BadgerCare Plus in those months.
SECTION 113. DHS 103.085 (4) and (5) are repealed.
SECTION 114. DHS 103.087 (1) (b) 1. and 2. are amended to read:
DHS 103.087 (1)(b) Applicability. 1. An applicant or recipient eligible for the medicaid purchase plan whose total earned and unearned income is at or above 150% 100% of the poverty line for the applicable household size shall pay a monthly premium and the applicant shall pay all retroactive premium amounts assessed or other premium payments due.
2. An applicant or recipient eligible for the medicaid purchase plan whose total earned and unearned income is at or below 150% 100% of the poverty line for the applicable household size need not pay does not owe a monthly premium.
SECTION 115. DHS 103.087 (1) (b) 3. is repealed.
