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Pregnant people with incomes above 306% of the FPL can qualify for BadgerCare Plus by meeting a deductible. The deductible amount is calculated for a six-month period using the amount of income that exceeds 300% of the FPL for pregnant people. The deductible is met by incurring medical expenses that equal the deductible amount. Pregnant people who could only qualify for the BadgerCare Plus Prenatal Program may not become eligible for the Prenatal Program by meeting a deductible. Note When determining the deductible amount, only the income of the applicant, the applicant's spouse, and, if the applicant is younger than 19 years old, the applicant’s parents, should be considered. If a sibling or other tax dependent has been counted as part of the applicant’s regular MAGI assistance group, the sibling's or tax dependent's income should be excluded for purposes of calculating the deductible; however, they should still be included in the assistance group size. This page last updated in Release Number: 25-02 Release Date: 04/09/2025 Effective Date: 02/22/2025 17.2 Pregnant Members 17.2.1 Introduction A pregnant member with assistance group income over 306% of the FPL must meet a deductible to become eligible for BadgerCare Plus. For a pregnant member, the deductible amount is the amount of countable income above 300% of the FPL for a six-month period. To meet the deductible, the pregnant member or other family members included in the BadgerCare Plus assistance group must incur medical bills equal to the pregnant member's deductible amount. Note If there is more than one pregnant member in the BadgerCare Plus assistance group, all of them become eligible when a deductible is met. If an individual applies before the pregnancy ends and meets the deductible while pregnant, they remain eligible for BadgerCare Plus for the rest of the pregnancy and through the end of the month 12 months after the end of the pregnancy. The member remains eligible for this period as a pregnant member regardless of when the deductible period ends. If an individual applies after the pregnancy ends and becomes eligible by meeting a deductible in backdated months, they are eligible for 12-month postpartum coverage. For eligibility regarding the BadgerCare Plus Prenatal Program for inmates of a public institution or non- qualifying immigrants, see SECTION 41.2 BADGERCARE PLUS PRENATAL PROGRAM ELIGIBILITY REQUIREMENTS. Example 1 Janet gives birth on June 30. On July 10, she applies for BadgerCare Plus and requests a BadgerCare Plus deductible period from April through September. Janet paid the full deductible amount, so she is certified from April 1 through June 30 (the end of the month in which her pregnancy ended). She is eligible for 12-month postpartum coverage until June 30 of the following year.

Example 2 Annette applies for BadgerCare Plus as a pregnant woman in May and requests a BadgerCare Plus deductible period from April to September. She gives birth on June 14. Annette paid the full deductible amount, so she is certified from April 1 through June 30 of the following year, including the 12-month postpartum coverage period.