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Wisconsin will only provide premium assistance when it is proven to be cost effective to do so. This means that the cost of providing family coverage is no greater than the cost of SCHIP direct coverage for the children. For instance, with a per member per month cost of $105 per child under BadgerCare Plus, we would not purchase family insurance that would cover three children if our cost was more than $315 per month.

Therefore, the cost of covering the entire family under BadgerCare Plus is less than the cost of covering children under the Standard Plan, as required under Section 2105(c)(3)(A).

6.4.2.2 The state assures that the family coverage would not otherwise substitute for health insurance coverage that would be provided to such children but for the purchase of family coverage. (Section 2105(c)(3)(B)) (42 CFR 457.1010(b))

BadgerCare Plus coverage of families will provide coverage for children who do not currently have access to affordable health care coverage. It will not substitute for coverage which currently covers the children but does not cover the parents.

6.4.2.3 The state assures that the coverage for the family otherwise meets title XXI requirements. (42 CFR 457.1010(c))

The State provides “wrap-around” benefits that cover any services not provided through the family coverage plan that are part of the regular SCHIP services provided under the plan.

WISCONSIN

Effective Date:

Approval Date: 33