BadgerCare Plus definition

BadgerCare Plus. The program that merges Family Medicaid, BadgerCare, and Healthy Start to form a comprehensive health insurance program for low income children and families. Coverage will include: • All children (birth to age 19) with incomes above 185 percent of the Federal poverty level (FPL). • Pregnant women with incomes between 185 and 300 percent of the FPL. • Parents and caretaker relatives with incomes between 185 and 200 percent of the FPL. • Caretaker relatives with incomes between 44 and 200 percent of the FPL. • Parents with children in xxxxxx care with incomes up to 200 percent of the FPL. • Youth (ages 18 through 20) aging out of xxxxxx care. • Farmers and other self-employed parents with incomes up to 200 percent of the FPL, contingent on depreciation calculations.

BadgerCare Plus means the Medical Assistance program described in this section.

BadgerCare Plus to read: BadgerCare Plus: Effective January 1, 2014, the following populations will be eligible for BadgerCare Plus: • Parents and caretakers with incomes at or below 100 percent of the Federal Poverty Level (FPL). • Pregnant women with incomes at or below 306 percent of FPL. • Children (ages 18 and younger) with household incomes at or below 306 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.

Examples of BadgerCare Plus in a sentence

• Policy on the Pharmacy Services Lock-In Program can be found in the BadgerCare Plus and Medicaid Pharmacy Provider Handbook.

• Members may visit the Wisconsin Medicaid and BadgerCare Plus Non-emergency Medical Transportation webpage for more information.

• 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.

• Rides can include public transportation such as a city bus, non-emergency ground ambulance, rides in specialized medical vehicles (SMV), or rides in other types of vehicles depending on a member’s medical transportation needs, as well as compensated use of private motor vehicles for transportation to and from BadgerCare Plus and Medicaid SSI covered services.

• Members who have commercial HMO insurance may be eligible for an exemption from a BadgerCare Plus or Medicaid SSI HMO if the commercial HMO does not participate in BadgerCare Plus or Medicaid SSI.

• This benefit is available for BadgerCare Plus and/or Medicaid SSI HMO enrolled adults (18 years and older) with a mental health and/or substance abuse diagnosis, especially members with a co-morbid diagnosis, who are at risk of hospitalization or who may have been hospitalized.

• If the mother is enrolled in a BadgerCare Plus HMO at the time of birth, and the child is reported to the certifying agency within 100 days of birth, the newborn will be enrolled in the same HMO as the mother back to the infant’s date of birth.

• If an infant weighs less than 1200 grams, the HMO or provider should check the box on the BadgerCare Plus Newborn Report.

• The exemption chart (Subsection 6 of this article) indicates whether the exemption is applicable to BadgerCare Plus or SSI HMO.

• These rosters will provide the HMO with ongoing information about its BadgerCare Plus and/or Medicaid SSI enrollees and disenrollees and will be used as the basis for the monthly capitation claim payments to the HMO.