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provided by the BadgerCare Plus program, BadgerCare Plus will provide "wraparound" services up to the Medicaid benefit level for these childrenWe will also apply the standard Medicaid fee-for-service utilization review policy and procedures to these "wraparound" services. The standard Medicaid fee-for-service utilization review policies and procedures are encompassed in the currently certified and operational MMIS Surveillance/Utilization Review subsystem.

Section 4. Eligibility Standards and Methodology. (Section 2102(b))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 5.

4.1 The following standards may be used to determine eligibility of targeted low-income children for child health assistance under the plan. Please note whether any of the following standards are used and check all that apply. If applicable, describe the criteria that will be used to apply the standard. (Section 2102)(b)(1)(A)) (42 CFR 457.305(a) and 457.320(a))

4.1.1

Geographic area served by the Plan:

Statewide.

4.1.2

Age: Separate SCHIP: Children from age 1 through age 5 with family income above 185% FPL up to and including 300%FPL and Children ages 6 through age 18 with family income above 150% FPL up to and including 300% FPL Unborn children from conception to birth up to and including 300% FPL.

Medicaid Expansion:

Children ages 6 through 18 with family income from above 100%FPL up to and including 150% FPL.

4.1.3

Income: Wisconsin has a 300% of the Federal poverty level gross income test without any deductions.

WISCONSIN

Effective Date:

Approval Date: 13