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A new deductible period can be established at any time before the current deductible has been met. A new application for the child must be signed and submitted 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 Jose applied for BadgerCare Plus for his 14-year-old child, Ellie, on April 1. Ellie is eligible for a deductible period from April 1 through September 30. She has not incurred enough expenses to meet the deductible. In July, the household’s income decreased, and they would like to have a new deductible period for Ellie from July 1 through December 31. Jose must submit a new, signed application for Ellie for the IM agency to establish a new deductible period. 17.3.2 Calculating the Deductible Amount To calculate the dollar amount of the BadgerCare Plus deductible for a child: 1. Determine the BadgerCare Plus deductible period. 2. Find the child’s assistance group's total countable income for each month in the deductible period. 3. If the assistance group’s total countable income includes the income of someone other than the child, the child’s parents, or, if married, the child’s spouse, subtract the income of that person, but do not change the group size of the AG. 4. Compare the total income of each month with 150% of the FPL. If a month's income is less than or equal to 150% of the FPL, ignore it. If a month's income is more than the income limit (150% of the FPL), find the excess income by subtracting the income limit from the income of that month. The child could choose to drop the deductible for months their income decreases so that the child is eligible to enroll in BadgerCare Plus. 5. Add together the excess income of the months in the deductible period. The result is the child’s BadgerCare Plus deductible amount. Example 1 Kyle is 14 years old, and his assistance group's income is over 156% of the FPL. Because of his age and assistance group's income amount, he is subject to the current employer-sponsored health insurance coverage policy. He is ineligible for BadgerCare Plus because he is covered under his mother’s employer-sponsored health insurance plan. The household’s size is five. Their income is $366.25 over the 150% FPL for a group size of five. Kyle’s six-month deductible amount is $2,197.50. (366.25*6=$2,197.50).

Example 2 Mark, who is five years old, is ineligible for BadgerCare Plus because his assistance group's income is over 306% of the FPL. The household is made up of Mark’s mother and 17-year-old brother whose income is counted because he is expected to be required to file taxes. Mark’s assistance group’s income is $3,026 over the 150% FPL for a group size of three. However, because Mark’s brother is not his parent or spouse, his income must be excluded from the deductible calculation. This reduces the excess income to $1,526. John’s six-month deductible amount is $9,156 ($1,526*6=$9,126).

This page last updated in Release Number: 25-02 Release Date: 04/09/2025 Effective Date: 02/22/2025