Page 9

2.3 Describe the procedures the state uses to accomplish coordination of SCHIP with other public and private health insurance programs, sources of health benefits coverage for children, and relevant child health programs, such as title V, that provide health care services for low- income children to increase the number of children with creditable health coverage. (Previously 4.4.5) (Section 2102)(a)(3) and 2102(c)(2) and 2102(b)(3)(E)) (42 CFR 457.80(c))

Applicants are eligible for BadgerCare Plus if they meet all of the following conditions:

- They are not currently enrolled in any group or individual health insurance plan as defined in HIPAA. - They have not been enrolled in a group or individual health plan meeting HIPAA criteria during the past six months. - They have not had access to a State employee’s health benefits plan in the previous 12 months. - They have not had access to a group or individual health insurance plan in the previous 12 months in which their employer pays at least 80 percent of the premium. Good cause is granted to family members of those individuals who have been or are currently covered, if the individual, through whom the insurance was available, has involuntarily lost their job with the employer providing that insurance, or the employer providing the health insurance coverage does not pay 80% or more of the premium; Persons who have access to employer health insurance that meets HIPAA standards and for which the employer pays at least 40 % but no more than 80% of the cost will be eligible for the health insurance premium purchase under BadgerCare Plus to assure that BadgerCare Plus does not substitute for private coverage. These provisions apply to the SCHIP expanded population only.

In families, where the state purchases employer subsidized family group health plan for a household that includes both Medicaid funded and SCHIP funded members, we will prorate the cost of the plan based upon the number of members in the family who are funded through SCHIP and the members funded through Medicaid. For example, if a family with a mother and two children, ages seven and nine, applies for BadgerCare Plus and we determine that their family income is 130% of the FPL, we will check with their employer to determine if we should enroll them in HIPP. If their family premium is $99 per month and that proves to be cost effective, the Department will purchase their employer's group health plan for the family and say that $66 of the premium that is intended for the two children will come from SCHIP and $33 will come from Medicaid funds.

The Department will comply with the applicable SCHIP premium assistance rules when determining whether the Department will pay for the employee portion of an employer- subsidized health insurance plan that covers SCHIP children.

WISCONSIN

Effective Date:

Approval Date: 9