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change, and Mary is no longer financially eligible for MAPP because the decrease in her out-of-pocket medical and remedial expenses increases her countable income. If Mary applied again using the same expenses, the IM agency would not allow the expenses because they are now known to be covered by Medicaid.

Example 9 Jim applies for MAPP. He verifies $500 in out-of-pocket medical expenses. Because the expenses are not above $500, these expenses cannot be allowed as an income deduction for the MAPP eligibility determination. This page last updated in Release Number: 26-02 Release Date: 04/15/2026 Effective Date: 04/15/2026 26.5 MAPP Premiums MAPP members with gross monthly income over 100% of the FPL will be charged a premium. MAPP applicants with gross monthly income over 100% of the FPL must pay an initial premium to enroll in MAPP. 26.5.1 Calculation Medicaid Purchase Plan (MAPP) premiums are calculated using only the member's income. A premium is calculated if the member's monthly Premium Gross Income exceeds 100% of the Federal Poverty Level (FPL) (see SECTION 39.5 FEDERAL POVERTY LEVEL TABLE) for a group of one. Tribal members are not exempt from paying MAPP premiums (unlike BadgerCare Plus premiums). Federal statutes for MAPP supersede other parts of the law that exempt tribal members from premiums and copayments for services. Eighteen-year-old MAPP members are not required to pay a premium. To calculate monthly premium amount: 1. Determine the member’s Premium Gross Income by adding together the member’s monthly gross earned income and gross unearned income. 2. Determine Countable Net Income by subtracting the following deductions from the member’s Premium Gross Income: a. The member’s own verified monthly impairment-related work expenses (any amount) b. The member’s own verified monthly out-of-pocket medical/remedial expenses (any amount) c. The current cost-of-living adjustment (COLA) disregard from January 1 through the date the FPL is effective in CARES for that year, if applicable 3. Determine Premium Net Income by subtracting 100% of the FPL for a group size of one from the countable net income. If this results in a negative number, change it to zero. 4. Multiply the premium net income by 3% (0.03). 5. Add the $25 Base Premium Amount and round down to the nearest whole dollar. 6. If applicable, add the Independence Account overage amount (see SECTION 26.5.1.1 INDEPENDENCE ACCOUNT PENALTY).