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• Infants younger than one year old • Children younger than 19 years old who are in a continuous coverage period • Children younger than 19 years old who have met a deductible (exempt only during the deductible period) • Children who are in an extension • Children ages one through five with household income at or below 191% of the FPL • Children ages six to 18 with household income at or below 156% of the FPL • Former Foster Care Youth • Pregnant persons and pregnant minors, other than those in the BadgerCare Plus Prenatal Program • All adults 19 years old or older Childless adults are not eligible for BadgerCare Plus if they are enrolled in any part of Medicare except Medicare Part B Immunosuppressive Drug Benefit (Part B-ID). This page last updated in Release Number: 25-02 Release Date: 04/09/2025 Effective Date: 02/22/2025 7.2 Reserved

This page last updated in Release Number: 25-02 Release Date: 04/09/2025 Effective Date: 02/22/2025 7.3 Reserved This page last updated in Release Number: 25-02 Release Date: 04/09/2025 Effective Date: 02/22/2025 7.4 Current Health Insurance Coverage 7.4.1 The Current Coverage Test for Children The Current Coverage Test policy applies to non-exempt children (see SECTION 7.1 HEALTH INSURANCE CONDITIONS OF ELIGIBILITY). These children who currently have individual or family health insurance coverage through an employed family member currently living in the household and who meets the following criteria are not eligible for BadgerCare Plus: 1. The child is not exempt from access and coverage policies (see SECTION 7.1 HEALTH INSURANCE CONDITIONS OF ELIGIBILITY); and 2. Coverage is provided by an employer; and the employer pays at least 80% of the premium or 3. Coverage is available under the state of Wisconsin employee health plan (regardless of plan type or premium amount contributed by state or local government), and 4. The insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence. Example 1 Dave applies for BadgerCare Plus in March for his family. The children's income exceeds 191% of the FPL. Dave is currently covered by family health insurance through his employer and the employer pays