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38.8.3.1 Premiums For members who are charged a monthly premium, the premium amount will be subtracted automatically when the member’s copay limit is calculated in CARES. 38.8.4 Changes to the Copay Limit Once determined, the copay limit will remain the same from month to month unless changes are reported that affect the copay limit, such as a change in income or household composition. Members have the right to appeal their monthly copay limit. Increases in copay limits may not be made without providing timely notice to the member. If a change results in an increase in the member’s copay limit and eligibility is confirmed prior to adverse action for the month, the copay limit increase will be effective the following month. If eligibility is confirmed after adverse action, the copay limit increase will be effective two months after the month in which the change occurred. If a change results in a decrease in the monthly copay limit, the decrease should be effective during the month in which the change occurred or, if the change was reported untimely (after the 10th of the month in which the change was supposed to be reported), the month in which the change was reported, whichever is later. 38.8.5 Meeting the Copay Limit Members are notified once they have incurred enough copays before the end of the month to meet their monthly copay limit. This notification is informational only and members may not appeal the date the copay limit was determined to have been met. Once the copay is met for a given month, it can never become “unmet” in the same month and the member will not be charged any more copays in that month. Example 4 Tamika is enrolled in BadgerCare Plus and has a copay limit of $13 for the month of August. On August 12, interChange notifies CARES that Tamika has met her copay limit of $13. CARES issues Tamika an automated notice stating that her $13 copay limit has been met for the month of August and that she will have no copays for the remainder of the month. On August 21, Tamika has a doctor’s appointment. She will have no copay for the doctor’s appointment since her copay limit has already been met for the month of August. Starting on September 1, Tamika will be responsible for copays incurred until her monthly limit is met. This page last updated in Release Number: 26-03 Release Date: 08/12/2026 Effective Date: 06/01/2026 39.1 Emergency Services Introduction BadgerCare Plus Emergency Services is a limited BadgerCare Plus benefit for documented immigrants who have not been in the U.S. for five years or more and for undocumented immigrants. An immigrant who is ineligible for BadgerCare Plus because of their immigration status is eligible for BadgerCare Plus Emergency Services coverage if they: 1. Meet the income limits listed in SECTION 39.1.1 EMERGENCY SERVICES INCOME LIMITS. 2. Meet all other BadgerCare Plus eligibility requirements, except having or applying for a Social Security Number (SSN).