DHS 103.03(1)(f)4g.4g. The child under subd. 4. is ineligible for BadgerCare Plus the first day of the month that the employer’s plan would have provided coverage for the child if the family had been enrolled in the plan. The child remains ineligible for each month that coverage would have been available up to 18 12 months from the month the failure to enroll in the plan occurred if the health insurance plan meets all of the following criteria:

DHS 103.03(1)(f)4g.a.a. The health insurance coverage is provided by an employer that pays 80% of the premium or coverage is available under the state of Wisconsin employee health plan.

DHS 103.03(1)(f)4g.b.b. The health insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.

DHS 103.03(1)(f)4g.c.c. The health insurance policy is through the child’s employer, the employer of the child’s spouse when the spouse is residing with the child, or the employer of the child’s parent, step-parent or other caretaker relative residing with the child.

DHS 103.03(1)(f)4r.4r. Except as provided in subd. 5., if the person is an unborn child, the unborn child’s mother did not, at any time in the 12 months immediately preceding application for BadgerCare Plus, have access to employer-subsidized health care coverage, or a state employee’s health plan. The unborn child is ineligible for BadgerCare Plus the first day of the month that the employer’s plan would have provided coverage for the unborn child’s mother if the family had been enrolled in the plan. The unborn child remains ineligible for each month that coverage would have been available up to 12 months from the month the failure to enroll in the plan occurred if the health insurance plan meets all of the following criteria:

DHS 103.03(1)(f)4r.a.a. The health insurance coverage is provided by an employer that pays 80% of the premium or coverage is available under the state of Wisconsin employee health plan.

DHS 103.03(1)(f)4r.b.b. The health insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.

DHS 103.03(1)(f)4r.c.c. The health insurance policy is provided through the mother’s employer, the employer of the mother’s spouse when the spouse is residing with the mother, or the employer of the mother’s parent, step-parent or other caretaker relative residing with the child, if the mother is under 19 years of age.

DHS 103.03(1)(f)5.5. The 12 month period in subds. 4. and 4m. does not apply if one of the following statements is true about access to employer-subsidized health care coverage:

DHS 103.03(1)(f)5.a.a. The employment ended.

DHS 103.03(1)(f)5.b.b. The person’s employer discontinued health care coverage for all employees.

DHS 103.03(1)(f)5.c.c. A member or members of the family were eligible for other health insurance coverage or MA at the time the employee failed to enroll in the employer-subsidized health care coverage and no member of the group was eligible at that time for BadgerCare Plus with an assistance group income above 156% of the federal poverty line.

DHS 103.03(1)(f)5.e.e. Any other reason determined by the department to be a good cause reason.

DHS 103.03(1)(f)8.8. A person has not chosen to receive BadgerCare Plus-related or SSI-related MA through a spend-down, as described in s. DHS 103.08 (2) (a), or has chosen to end a spend-down period at any time prior to the date at which the expenditure or obligation of excess income has been achieved.

DHS 103.03(1)(fm)(fm) Exemption from health insurance coverage requirements. A child is exempt from the health insurance coverage requirements in sub. (1) (f) 2., 3., and 4., if they meet any of the following criteria:

DHS 103.03(1)(g)(g) Medicaid purchase plan non-financial eligibility. To be non-financially eligible for the medicaid purchase plan a person shall meet the conditions described in par. (c) for SSI-related persons and shall be age 18 or older and the person shall meet any of the following conditions:

DHS 103.03(1)(g)1.a.a. The person shall be employed.

DHS 103.03(1)(g)1.b.b. The person shall be enrolled in a department-certified health and employment counseling program.

DHS 103.03(1)(g)1.c.c. The health of the person participating in the medicaid purchase plan for at least 6 months shall have deteriorated to the point that he or she is unable to participate under subd. 1. a. or b. and the county agency has waived the requirement for a period up to 6 calendar months. The county agency may waive the requirement if the person is hospitalized, injured or suffers any other health setback. The county agency may waive the requirement as long as it had not granted a waiver of the requirement twice within the 36 months immediately preceding the current waiver request. The waiver periods shall be non-consecutive. The person shall supply proof of health difficulties. In addition to the discretion the county agency has to grant a waiver, the department may grant a temporary waiver of the work requirement upon a showing of good cause.