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Enrollment Policy
Q: If a 2 parent family has 5 kids (2 born in the USA and 3 born in
outside of USA - non-resident) what number is used when determining size of
family?
A: In the BC+ Handbook, the section on Citizenship and Immigration (4) states
that all U.S. citizens and U.S. nationals are entitled to apply for and receive
BC+ if they provide documentation of their citizenship and identity and meet all
other eligibility requirements. The 2 children born in the USA are citizens, and
therefore they may be eligible as long as they provide documentation and meet
other eligibility requirements (such as income and residence). With respect to
BC+ , “residence” refers to if the person lives in or intends to live in WI,
and is not related to immigration. Under BC+ Handbook 2.4, every BC+
Assistance Group will have at least one potentially eligible member.
Besides these potentially eligible members, others in the household may be
designated as a person whose income will be counted when determining financial
eligibility.
Therefore, if the parents and other 3 children are non-qualifying
undocumented immigrants and are not pregnant, they will not be eligible, but the
2 children who are us citizens may be eligible. The adults’ incomes will be
considered. The non-qualifying undocumented family members may be eligible for
BC+ Prenatal and Emergency MA.
Q: Are pregnant women between 200% and 300% of FPL who have access to
employer insurance are required to take that insurance?
A: Pregnant women whose household income is between 200-300% of FPL who have any
kind of major health insurance plan are not eligible for BadgerCare Plus.
Good cause reasons for dropping employer-sponsored health insurance for
pregnant woman only:
- Her coverage was COBRA continuation coverage and the coverage was
exhausted in accordance with federal regulations concerning COBRA.
- The insurance does not pay for pregnancy-related services.
- The insurance is owned by someone not residing with the pregnant
woman and continuation of the coverage is beyond her control.
- The insurance only covers services provided in a service area
that is beyond a reasonable driving distance.
With the exception of pregnant women enrolled in the BC+ Prenatal Program,
pregnant women and pregnant minors:
- With income above 200% FPL and
- Who were enrolled in BC+ in the month in which they dropped the insurance
coverage,
are not eligible for BadgerCare Plus for the three calendar months following
the month in which the major medical health insurance coverage ended, unless
there was good cause for ending the coverage.
This applies to pregnant women with coverage under any major medical health
insurance plan which meets the standards of a (HIPAA) standard plan. The
insurance plan:
- Can be individual or family coverage.; and
- Does not have to be employer based; and is not BadgerCare, BadgerCare
Plus, Medicaid, Medicare Managed Care (aka Medicare Choice Plus), Medicare,
Medicare Supplemental policies, HIRSP, General Relief, General Assistance,
or Family Health Plan (Marshfield clinics).
Q: Do I need to get a new card for BadgerCare Plus?
A: If you have been enrolled under BadgerCare, you will not need to get a new
card for your services.
Q: Will the Forward card be changing?
A: The Forward Card’s appearance will change for new enrollees, and will say
“Forward Health”. People who already have a Forward card can continue using
it. The BC+ Enrollment and Benefits Manual (http://dhfs.wisconsin.gov/em/impubs/pubs/phc-10167.pdf
)shows the cards on page 2.
Q: Will pregnant non-qualified immigrants be on the benchmark or standard
plan?
A: Neither. To be eligible for the BadgerCare Plus Benchmark or Standard Plan,
applicants must be US citizens or qualified immigrants. A pregnant non-qualified
immigrant woman may be eligible for the BC+ Prenatal Program is she meets the
non-financial and financial eligibility requirements for BC+ and has a verified
pregnancy.
Q: Can incarcerated pregnant women and women in Huber, be able to do
Express Enrollment? Can they obtain coverage under Badgercare Plus?
A: No. Inmates of public institutions are not eligible for the general
BadgerCare Plus program, unless the person is a Huber Law prisoner who is
released from jail for the purpose of attending to the needs of their family.
However, they would be eligible for the BC+ Prenatal Program, which provides
coverage for women who:
- Meet the non-financial and financial eligibility requirements for BC+
- Have verified pregnancies, and
- Are not eligible for BC+ because they are either inmates of a public
institution or non-qualifying immigrants Non-qualifying immigrants are
individuals that are not eligible for BC+ due to immigration status.
Q: We understand that Emergency Services eligibility is extended to 300%
of the FPL. Will individuals eligible for ES be evaluated under the benchmark plan if they have
income between 200-300% of the FPL?
A: Non-qualified immigrants will receive Emergency Services under standard plan
coverage with no co-payments or premiums.
Immigrants who apply for Emergency Services and who are under 19 years of age
and ineligible due to access to health insurance or who are pregnant and have
countable household income over 300% of the FPL, may become eligible for BC+ Emergency Services by incurring health care expenses to meet the deductible.
Q: Can you explain the coverage for Kinship Care caregivers and what the
differences are for voluntary and court-ordered caregivers/parents?
A: A caretaker relative a is non-legally responsible relative to the child under
his/her care. Caretaker relatives and their spouses can be eligible for BC+ as
caretaker relatives. To be considered a caretaker relative of a child in
the home, a person must first have a qualifying relationship to the child (under
age 19) and the child must also be under the care of that relative.
Qualifying relationships for caretaker relatives consist of the following:
- Stepfather or stepmother
- Natural full brother or sister, legally adopted, half- or stepbrother or
sister.
- Grandmother or grandfather, aunt or uncle, first cousin, nephew or niece,
or any preceding generation denoted by the prefix grand-, great-, or
great-great, and including those through adoption.
- Spouse of any of the above even after the marriage ends by death, divorce,
or separation.
(This information is from the BadgerCare Plus handbook, 2.2.2) Information on
the Kinship Care program is available online at: http://dhfs.wisconsin.gov/Children/Kinship/.
Q: What are the rules related to COBRA and exceptions to losing health
insurance through no fault of your own? Is there a three-month wait for a person
who voluntarily drops his/her COBRA coverage?
A: COBRA coverage will only be of concern for:
- A pregnant woman in the prenatal program group, and
- A pregnant woman with income over 200% of poverty and who has COBRA
coverage at the time that she is eligible for BC+ benefits as a pregnant
woman.
For a woman in one of these situations, she is ineligible for the three
calendar months following the month the COBRA coverage ends unless her coverage
was exhausted. (Usually after 18 months.)
Q: For children aging out of foster care, there are no
income/asset/resource tests, and yet the BC+ Handbook mentions that some of them
can be “otherwise ineligible” – how can this be? Please provide an example
or case study if possible.
A: A Youth must also meet the following eligibility requirements to receive BC+
- Provides a Social Security Number or cooperates in applying for one.
- Is a U.S. Citizen, or National, or is a qualifying immigrant.
- Provides verification of U.S. citizenship and identity or qualifying
immigration status or makes a good faith effort to obtain it.
- Cooperates with child support enforcement agencies in obtaining medical
support (if a parent).
- Cooperates with third party liability requirements.
- Physically resides in Wisconsin and intends to reside in the state.
- Is not an inmate.
- Cooperates with Health Insurance Premium Payment (HIPP) requirements.
Q: If a child ages out of foster care in a different state, can s/he still
qualify for BC+ in Wisconsin?
A: Yes.
Q: How will lines of legal responsibility be identified in multiple-family
households? How do we identify the correct fiscal test group (FTG)?
A: BC+ Test groups will consist of parents, children and spouses. IM agencies
have the responsibility of identifying the correct FTG.
Q: How do all these groups relate: test group, assistance group,
household?
A: The Test Group consists of all persons in the home who will in some way be
looked at to determine BC+ eligibility for the applicants. This includes all
persons who will be included in the group size to determine eligibility, those
persons whose income is being counted to determine eligibility as well as those
persons requesting BC+ who can be included in the same case as the person who is
applying.
The Assistance Group is a designation used by the CARES system to group
members of the case into units that have the same eligibility rules applied to
them when determining BC+ eligibility. It’s also of value to Income
Maintenance (IM) agency staff is to help them interpret the CARES eligibility
results. Household just refers to the persons living together at an
address. We require applicants to list everyone they live with on an application
so that IM staff may determine who must be included in the BC+ Test Group. The
CARES Worker Web and ACCESS determine who is relevant to the programs of
assistance that are being requested and does not collect information from
household members whose presence is irrelevant to the determination of
eligibility.
Q: Under what circumstances is a child an “excluded child?” When is an
adult an “excluded adult?” How do we allocate income?
A: “Excluded” children and adults are persons in a household who have no
relationship to the applicant or anyone else in the BC+ Test Group. For example,
an unrelated adult without any children in common with the primary person (or
anyone else in the BC+ Test Group) would be an excluded adult. We would not
count his/her income or presence in the home when determining BC+ eligibility
for the others in the home.
Q: Will there be families who have one parent on the Benchmark Plan and
their kids on the Standard Plan?
A: Yes, but these situations should not happen often.
Q: Are both parents, even those with joint custody agreements, going to be
able to access BadgerCare coverage?
A: Yes, but only if they have a roughly equal placement arrangement (children
are with each parent at least 40% of the time).
Q: Past BadgerCare recipients have been converted into BadgerCarePlus but
with an outcome that doesn't seem correct. It is a case of a family consisting
of 2 parents and 2 children who have ended up in 2 different plans. The children
are getting the lesser benefit, Benchmark Plan, and the parents are getting the
Standard Plan. Can this be correct?
A: This can plausibly happen due to the different budgeting methods being used.
The parents are actually ineligible for BC+ but are 'transitionally
grandfathered' into the Standard Plan with a premium for 12 months. The children
are now eligible above the 200% FPL and therefore are now in the Benchmark Plan
with a premium. Those recipients who get the 12 month Transitional Grandfather
benefit are always in the Standard Plan.
Q: What adults qualify for coverage that previously did not, and what
verification is needed to prove these relationships? What verification needs to
be provided for a caretaker that is a non-legal responsible adult to qualify for
benefits?
A: A non-legally responsible relative of a child may apply for BC+ as a
caretaker, if s/he is a qualified relative through blood or marriage and the
child is under the care of that relative. “Under the care” means the
caretaker exercises primary responsibility for the child’s care and control.
To the extent that the IM agency has questions about either the relationship or
the responsibility the relative is exercising for the child, they may request
documentation to support those claims. For example, they may ask for birth
certificates to prove the qualified relationship, or they may ask for school or
child welfare agency records that show the relative is responsible for the
child, instead of a parent.
Q: How are newborns handled?
A: Newborns are handled pretty much the same way were under BadgerCare. If the
mom was eligible for BC+ (except the prenatal benefit) at the time of the birth
and the child is living with the mother in Wisconsin , the infant is eligible
for BC+ for the first year. That is called the Continuously Eligible Newborn (CEN)
coverage and it still exists in BC+ . The hospitals still send the birth
information to EDS and they do the initial certification of the infant from the
date of birth. The main difference is that if the mother was in the Benchmark
Plan at the time of the baby’s birth, then the Newborn is also put into the
Benchmark Plan.
Q: Do they qualify for express enrollment?
A: They could, but only if their family income is below 150% of poverty.
However, if they qualify for newborn coverage, there isn’t much need to
request express enrollment.
Q: What if their mother is not a citizen or is on SSI?
A: If the mother is only eligible for the BC+ Prenatal benefit because she is
not a citizen or a qualified immigrant, then the child is not eligible for CEN
coverage. In those cases, the parent would just need to tell their IM worker
that they want BC+ for the infant.
However, for non-citizens whose labor and delivery was covered by Emergency
Services, not BC+ Prenatal, their child can be eligible for CEN coverage for the
first year. There are different federal rules covering Emergency Services which
is why the policy differs.
A child born to a mom on SSI may qualify for CEN coverage.
Q: Are people without children who are over 18 years of age able to get
BadgerCare Plus?
A: The groups without dependent children who can get BadgerCare Plus or Medicaid
are:
- youths exiting out of foster care who turn 18 on or after January 1, 2008.
- people over age 65
- people who are blind
- people who have a disability
- caretaker relative of children under age 19
Badger Care Plus for childless adults will begin in 2009 for those with
incomes below 200% of the Federal Poverty Level.
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