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Emergency Services for the remainder of their 12-month continuous coverage period. Once the child is enrolled in Emergency Services, Medicaid will only cover claims related to medical emergencies. Children enrolled in a Children’s Health Insurance Program (CHIP) funded category of BadgerCare Plus cannot be transitioned to Emergency Services unless they simultaneously experience a change that makes them eligible in a Medicaid-funded category of BadgerCare Plus, such as a reduction in household income. When a child experiences these changes simultaneously, they begin a new 12-month certification period with continuous coverage in BadgerCare Plus Emergency Services. If a child is no longer in an eligible immigration status or designation and they do not have a change that makes them eligible for Medicaid, their BadgerCare Plus eligibility will end. Example 9 Tania is 12 years old and enrolls in BadgerCare Plus on February 1. She is verified as a non-citizen who is lawfully present in the United States with Temporary Protected Status (TPS). Her household income is 125% of the FPL. Tania’s continuous coverage period is set from February 1 through January 31 of the following year.

On June 10, information from CMS requires the agency to verify Tania’s status. The information available on the case is submitted to SAVE. SAVE does not verify Tania’s immigration status or designation. Tania is sent a notice requesting verification of her immigration status and is placed in a Reasonable Opportunity Period (ROP). Requested information is not returned. Tania’s BadgerCare Plus full benefit coverage ends in accordance with ROP requirements and with timely notice. Tania is certified for BadgerCare Plus Emergency Services through January 31. Example 10 Henrik is 10 years old and enrolls in BadgerCare Plus on September 1. Henrik is verified as a non-citizen who is lawfully present in the United States with a pending asylum application. His household income is 175% of the FPL. Henrik’s continuous coverage period is set from September 1 through August 31 of the following year.

On January 12, information from CMS requires the agency to verify Henrik’s status. The information available on the case is submitted to SAVE. SAVE verifies Henrik is not currently in an eligible immigration status or designation. Henrik’s BadgerCare Plus full benefit coverage ends with timely notice. Henrik cannot be certified for BadgerCare Plus Emergency Services because he is over the BadgerCare Plus Emergency Services income limit. 1.2.6 Premiums A child can have a new premium obligation at application or renewal but cannot have a new premium once their 12-month continuous coverage period starts. Existing premiums for an individual child cannot increase during their 12-month continuous coverage period, but they 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. Note The restriction against new or increased premiums during an established continuous coverage period does not apply if the child’s eligibility determination at application or renewal was based on incorrect information or agency error (see SECTION 1.2.3.1 WHEN ELIGIBILITY WAS BASED ON INCORRECT INFORMATION OR AGENCY ERROR). Example 11 Kiley and Korbin are enrolled in BadgerCare Plus as of July 1, 2024. They each owe a $20 premium, for a total household premium of $40. Their individual premiums of $20 cannot increase during their 12- month period. The household has a reduction in income in December 2024, and their premiums lower to $10 each. Their premiums now cannot go above $10 for the rest of the 12-month period. If the household has an increase in income at any point in their remaining certification period, their premiums will not increase.