BadgerCare Plus Sample Clauses
BadgerCare Plus. BadgerCare Plus is Wisconsin’s health care program for low income individuals that merged BadgerCare, the family portion of the current Wisconsin Medicaid population, with Healthy Start to form a single program that expands coverage to Wisconsin residents. Effective April 1, 2014, the following populations are eligible for BadgerCare Plus:
a. Parents and caretakers with incomes at or below 100 percent of the Federal Poverty Level (FPL).
b. Pregnant members with incomes at or below 300 percent of FPL.
c. Children (ages 18 and younger) with household incomes at or below 300 percent of the FPL.
d. Childless adults with incomes at or below 100 percent of the FPL.
e. Transitional medical assistance individuals, also known as members on extensions, with incomes over 100 percent of the FPL.
BadgerCare Plus. The Wisconsin State Program for which, effective January 1, 2014, the following populations will be eligible:
i) Parents and caretakers with incomes at or below 100 percent of the Federal Poverty Level (FPL);
ii) Pregnant women with incomes at or below 300 percent of FPL;
iii) Children (ages 18 and younger) with household incomes at or below 300 percent of the FPL;
iv) Childless adults with incomes at or below 100 percent of the FPL; and
v) Transitional medical assistance individuals, also known as members on extensions, with incomes over 100 percent of the FPL.
BadgerCare Plus. Effective January 1, 2014, the following populations are eligible for BadgerCare Plus: • All children (ages 18 and younger) with incomes at or below 306 percent of the Federal poverty level (FPL). • Pregnant women with incomes at or below 306 percent of the FPL. • Parents and caretaker relatives with incomes at or below 100 percent of the FPL. • Childless adults with incomes at or below 100 percent of the FPL. • Transitional medical assistance individuals, also known as members on extensions, with incomes over 100 percent of the FPL.
BadgerCare Plus. The PIHP may request disenrollment when a member is in the nursing home longer than 30 days and is expected to remain in the facility. The PIHP must wait 30 days before requesting an exemption, which will be effective the first of the next month. Commercial Insurance Members who have commercial insurance (PIHP or otherwise) may be eligible for an exemption from a BadgerCare Plus or Medicaid SSI PIHP if the commercial insurance does not participate in BadgerCare Plus or Medicaid SSI. In addition, members who have commercial insurance that limits them to a restricted provider network (e.g., PPOs, PHOs, etc.) may be eligible for an exemption from enrollment in a BadgerCare Plus or Medicaid SSI PIHP. The member requests this exemption and it is approved by the Enrollment Specialist or fiscal agent. This exemption lasts for one year. The PIHP may request assistance from the Department’s contracted Enrollment Specialist in situations where the member has commercial insurance that limits the members to providers outside the commercial insurance plan’s network. When the Department’s member eligibility file indicates commercial PIHP coverage limiting a member to providers outside the WI FCMH PIHP network and the member seeks services from the WI FCMH PIHP network providers, the WI FCMH network providers may refuse to provide services to that member and refer them to their commercial network, except in the case of an emergency. Experimental Transplant Members who have had a transplant that is considered experimental such as a liver, heart, lung, heart-lung, pancreas, pancreas-kidney, stem cell or bone marrow transplant shall have a permanent exemption from PIHP enrollment. Kidney and cornea transplants are not experimental.
a. The exemption will begin on the first day of the month in which the surgery is performed.
b. For autologous bone marrow transplants, the person will be permanently exempted from PIHP enrollment beginning on the date the bone marrow was extracted.
BadgerCare Plus. The HMO may request disenrollment when a member is in the nursing home longer than 30 days and is expected to remain in the facility. The HMO must wait 30 days before requesting an exemption, which will be effective the first of the next month. Commercial Insurance Members who have commercial insurance (HMO or otherwise) may be eligible for an exemption from a BadgerCare Plus or Medicaid SSI HMO if the commercial insurance does not participate in BadgerCare Plus or Medicaid SSI. In addition, members who have commercial insurance that limits them to a restricted provider network (e.g., PPOs, PHOs, etc.) may be eligible for an exemption from enrollment in a BadgerCare Plus or Medicaid SSI HMO. The member requests this exemption and it is approved by the Enrollment Specialist or fiscal agent. This exemption lasts for one year. The HMO may request assistance from the Department’s contracted Enrollment Specialist in situations where the member has commercial insurance that limits the members to providers outside the commercial insurance plan’s network. When the Department’s member eligibility file indicates commercial HMO coverage limiting a member to providers outside the BadgerCare Plus and/or Medicaid SSI HMO network and the member seeks services from the BadgerCare Plus and/or Medicaid SSI HMO network providers, the BadgerCare Plus and/or Medicaid SSI network providers may refuse to provide services to that member and refer them to their commercial network, except in the case of an emergency.
BadgerCare Plus. Benchmark and Core Plan All non-emergency transportation, including common carrier transportation, is not a covered service under the Benchmark Plan.