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Example 6 Mary is charged a premium for her son, Jack, beginning May 2024. A statement is sent to Mary at the end of April, with a due date of May 10. Mary is not able to pay the premium. Jack remains eligible for BadgerCare Plus. Mary will be sent a premium statement for June at the end of May. The following children are exempt from being charged a premium for BadgerCare Plus: 1. Pregnant minors 2. Former Foster Care Youth (see CHAPTER 11 FOSTER CARE MEDICAID) 3. Children who have met a BadgerCare Plus deductible, during the remainder of the deductible period 4. Children in a BadgerCare Plus extension 5. All children under age one including Continuously Eligible Newborns (see SECTION 8.2 CONTINUOUSLY ELIGIBLE NEWBORNS) 6. American Indian or Alaskan Native Tribal members, the son or daughter of a tribal member, the grandson or granddaughter of a tribal member, or anyone otherwise eligible to receive Indian Health Services 7. Children whose BadgerCare Plus is suspended due to being incarcerated in jail or prison Note Persons who are members of families receiving BadgerCare Plus benefits, but who are individually certified for Elderly, Blind or Disabled (EBD) Medicaid, Wisconsin Well Woman Medicaid, Family Planning Only Services or Emergency Services, are not charged a BadgerCare Plus premium. This page last updated in Release Number: 24-02 Release Date: 08/22/2024 Effective Date: 08/22/2024 19.2 Premium Calculations 19.2.1 Premium Calculations Premiums are initially calculated on an individual basis and then a total for the case is determined. The general rules for calculating the premium amounts are explained below. 1. The minimum monthly premium amount is $10 per child. 2. The maximum monthly premium for a child with income above 301% up to 306% Federal Poverty Level (FPL) is $97.53. 3. Each child’s premium amount will be based on their assistance group’s (AG) size and income. Under Modified Adjusted Gross Income (MAGI) rules, it is possible for different children within the same household to have different amounts of income counted and to have different AG sizes. For this reason, each child’s AG is evaluated separately to determine that AG’s income and group size, which is the basis for determining the FPL percentage of that child’s income. That FPL percentage, in turn, will determine whether a child potentially owes a premium and the amount of the premium. 4. The premium for the BadgerCare Plus group is the total of the individually-calculated premiums combined, not to exceed 5% cap. 5. The cap will be 5% of the income of the AG with the highest income (in terms of dollar amount) in the case (see SECTION 19.3 PREMIUM LIMITS). A child cannot be charged a new or increased premium during their 12-month continuous coverage period, but their premium may be reduced, if applicable. If the premium is lowered, that new amount becomes their premium cap for the rest of the 12-month period.