Page 171

17.2.2 Deductible Period A pregnant member can choose to begin the BadgerCare Plus deductible period as early as three months prior to the month of application, and as late as the month after the month of application. A pregnant member can choose a BadgerCare Plus deductible period which includes a month in which they are ineligible for a non-financial reason, with one exception. A deductible period may not begin with a month in which the pregnant member is non-financially ineligible. Although excess income is still calculated over a six month period, the individual may only be certified for BadgerCare Plus during the dates when they are non-financially eligible. Example 1 Luanne applied for BadgerCare Plus as a pregnant woman on June 1 and requested a BadgerCare Plus deductible period from April through September. She gave birth on June 2. Luanne 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. A new deductible period can be established at any time before the current deductible has been met. The person must sign and submit a new application in order for the new deductible period to be established. A new application is required regardless of when the previous deductible period was established or if anyone in the household is eligible for another health care program. Example 2 Julie is pregnant and due November 15. She applied for BadgerCare Plus April 1. She is eligible for a deductible period from April 1 through September 30. She has not incurred enough expenses to meet the deductible. In July, Julie’s income decreased, and she would like to have a new deductible period from July 1 through December 31. Julie must submit a new, signed application for the IM agency to establish a new deductible period. A pregnant member who is ineligible due to excess income in some backdated months, but has no excess income in others, does not have to choose to have a BadgerCare Plus deductible. They can choose to be certified in the months they are eligible and to accept the ineligibility of the other months when they had excess income. Example 3 Rachel is pregnant and applied for BadgerCare Plus in July. Her due date is in December. She had no income and did not expect any income in the future. She was eligible in July. She also requested BadgerCare Plus eligibility for April to cover some medical expenses she had in April. In April and May, she had income in excess of 300% of the FPL. In June, she would have been eligible because she had no income. In April and May, her income was over 300% of the FPL by $200 a month. She has two choices: 1. Choose a BadgerCare Plus deductible period of April through September. After meeting the BadgerCare Plus deductible of $400, she would be certified for BadgerCare Plus from April through 12-months past the end of the pregnancy. 2. Not choose a BadgerCare Plus deductible period. She would not have to meet a BadgerCare Plus deductible. She could be certified immediately for June through 12 months past the end of the pregnancy but would have to forgo BadgerCare Plus for April and May because of the excess income in April and May. 17.2.3 Calculating the Deductible Amount To calculate the dollar amount of the BadgerCare Plus deductible for a pregnant woman: 1. Determine the BadgerCare Plus deductible period. 2. Find the BadgerCare Plus group's total countable income for each month in the deductible period.