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Actual income is used to determine backdated eligibility under gap filling rules for months in a past calendar year. When determining backdated eligibility under gap filling rules for months in the current calendar year, expected annual income is assessed using the same process for non-backdated months. The reasonable compatibility test is used when determining backdated eligibility (see SECTION 9.12 REASONABLE COMPATIBILITY FOR HEALTH CARE). If the reasonable compatibility test is passed, further verification of income may not be requested or required. If the reasonable compatibility test is not passed, further verification of income is required. See SECTION 16.4.3.4.4 BACKDATED MONTHS for information on counting self-employment income for backdated months. 25.8.2.3 Medical Bills During Backdated Eligibility Period If a member has incurred a bill from a BadgerCare Plus certified provider during a backdate period, the member must contact the provider to inform them to bill BadgerCare Plus. The member may be eligible to receive a refund up to the amount the member already paid. Example 1 Mary, who is pregnant with an August due date, applied for BadgerCare Plus on April 6, and was found eligible. At the time of application, Mary did not request a backdate. In September, Mary is billed for a doctor’s appointment she had at the end of February. Mary asks to have her eligibility backdated through February. She meets all nonfinancial and financial eligibility criteria in the months of February and March and is enrolled in BadgerCare Plus for both months. Example 2 Crystal applied for and was determined eligible for BadgerCare Plus effective February 1. She contacts her IM agency in April to see if she is eligible for coverage back to December 1 of the previous year. Crystal had previously reported no income for the month of January. The worker finds no information contrary to what Crystal reported. She is determined eligible for backdated benefits for the month of January.

However, Crystal reported that she received unemployment benefits in the previous year and had a seasonal job from November 1 through December 31. Her last paycheck was received on December 31. Crystal reports she earned $5,000 from the two-month seasonal job. Based on her monthly income ($2,500), she is not eligible for BadgerCare Plus in December.

Crystal’s annual income is reviewed for the previous year to see if she may be eligible based on annual income gap filling rules. A SWICA match shows that she earned a total of $5,000 during the fourth quarter of the previous year. The unemployment compensation query shows that Crystal received a total of $3,200 in unemployment benefits during the previous year. Her annual income for the previous year is $8,200 ($5,000 from wages earned and $3,200 from unemployment benefits). Her annual income for the previous year is below 100% of the FPL. Crystal is eligible for backdated benefits under gap filling rules for the month of December. 25.8.2.4 Family Planning Only Services Eligibility for FPOS begins on the first of the month of application if all nonfinancial (see SECTION 40.4 NONFINANCIAL REQUIREMENTS) and financial (see SECTION 40.5 FINANCIAL REQUIREMENTS) eligibility requirements are met. FPOS may be backdated up to three months prior to the month of application. 25.8.2.5 Pregnant Members Except for those members eligible only under the BadgerCare Plus Prenatal Program, backdate a pregnant member to whichever is more recent: