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26.1.5 Program Changes at Renewal If health care coverage was maintained during a renewal, and the member’s enrollment changes to a new health care program or has a reduction in their premium, their eligibility may need to be redetermined for the month(s) that coverage was maintained. After a renewal is processed, if a member’s enrollment changes from a limited-benefit to a full-benefit health care program, the eligibility in the new program may need to be redetermined for the months that coverage was maintained and any month in which the member may be eligible for the new health care program. Example 1 Tom is enrolled in Family Planning Only Services (FPOS). His FPOS renewal is due in February. He submits a renewal on February 3. Verification is requested with a due date of February 23. Because his renewal was received timely, his FPOS coverage is maintained for March. Verification is received on February 19. Tom's income has decreased to below 100% FPL. Tom had a prior health care request on file, so he is now determined eligible for BadgerCare Plus with a new certification period starting April 1. Although FPOS was maintained through March, Tom is also enrolled in BadgerCare Plus for February and March. Eligibility must be retroactively determined in situations where health care coverage was maintained for one household member and, after the redetermination of eligibility, another household member that was previously not eligible for health care is newly eligible. Eligibility is determined back to the date the change was reported. Example 2 John and his wife Julieta both applied for health care. Julieta was denied BadgerCare Plus due to being over income for her tax filing group size, but John opened for BadgerCare Plus. John is due for renewal in February. On February 3, the renewal is submitted. Verification is requested with a due date of February 23. John’s BadgerCare Plus coverage is maintained for March. Verification is received on February 19. An income decrease makes both John and Julieta eligible for BadgerCare Plus with a new certification period starting April 1. However, because the income reduction was reported and verified in February, Julieta’s eligibility for BadgerCare Plus is determined retroactively for February and March. This page last updated in Release Number: 26-03 Release Date: 08/12/2026 Effective Date: 08/12/2026 26.2 Administrative Renewals 26.2.1 Administrative Renewals Introduction Based on federal requirements, health care eligibility must be redetermined once every 12 months based on information available to an agency. Agencies cannot require information from health care members during an annual renewal unless the information cannot be obtained through an electronic data exchange or the information from the electronic data exchange is not reasonably compatible with the information on file. The process of using electronic data exchanges for renewals is referred to as the administrative renewal process. If information from electronic data exchanges validated information about a member’s income as currently recorded in CARES, additional information about income cannot be requested from the member at renewal. This includes member-reported information about earned income that is found to be reasonably compatible with earned income information obtained from the State Wage Information Collection Agency (SWICA) and Federal Data Services Hub (FDSH) data exchanges, as well as any information about unearned income verified through the Social Security Administration (SSA) or