us-wi/statute/49.471/10 — Cost sharing.

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(b)Premiums.#

1. Except as provided in subds. 1m. and 4., a recipient who is an adult, who is not a pregnant woman, and whose family income is greater than 150 percent but not greater than 200 percent of the poverty line shall pay a premium for coverage under BadgerCare Plus that does not exceed 5 percent of his or her family income. 1m. Except as provided in subd. 4., a recipient who is an adult parent or adult caretaker relative; who is not disabled, pregnant, or American Indian; and whose family income exceeds 133 percent of the federal poverty line shall pay a premium for coverage under BadgerCare Plus in an amount determined by the department that is based on a formula in which costs decrease for those with lower family incomes and that is no less than 3 percent of family income but no greater than 9.5 percent of family income. If the recipient has self-employment income and is eligible under sub. (4) (b) 4., the premium may not exceed 5 percent of family income calculated before depreciation was deducted. If the department intends to impose a premium under this subdivision after December 31, 2013, the department shall request from the federal department of health and human services any necessary approval to continue imposing premiums under this subdivision. 2. Except as provided in subds. 3m. and 4., a recipient who is a child whose family income is greater than 200 percent of the poverty line shall pay a premium for coverage of the benefits described in sub. (11) that does not exceed the full per member per month cost of coverage for a child with a family income of 300 percent of the poverty line. 3m. A recipient who is a child, who is not disabled, and whose family income is at a level determined by the department that is at least 150 percent of the poverty line shall pay a premium in an amount determined by the department. The department may apply this subdivision only to the extent the federal department of health and human services approves applying a premium to those individuals, if approval is required. 4. None of the following shall pay a premium, except as provided in subd. 3m.: a. A child who is a Native American or an Alaskan Native with a family income that does not exceed 300 percent of the poverty line. b. A child who is eligible under sub. (4) (a) 2. or 2m. c. A child whose family income does not exceed 200 percent of the poverty line. d. A pregnant woman whose family income does not exceed 200 percent of the poverty line. e. A child who obtains eligibility under sub. (7) (b) 2. f. An individual who is eligible under sub. (4) (a) 5. g. An individual described in sub. (4) (a) 7. 5. If a recipient who is required to pay a premium under this paragraph or under sub. (2m) either does not pay a premium when due or requests that his or her coverage under this section be terminated, the recipient’s coverage terminates. If the recipient is an adult, the recipient is not eligible for BadgerCare Plus for 12 consecutive calendar months following the date on which the recipient’s coverage terminated, except for any month during that 12-month period when the recipient’s family income does not exceed 133 percent of the poverty line. If the recipient is a child, the recipient is not eligible for BadgerCare Plus for 3 consecutive calendar months, or up to 12 consecutive calendar months if the federal department of health and human services approves, following the date on which the recipient’s coverage terminated, except for any month during that period when the recipient’s family income does not exceed 150 percent of the poverty line. This period of ineligibility for a child does not apply to any child who has paid the outstanding premiums.

(b)(1)#

Except as provided in subds. 1m. and 4., a recipient who is an adult, who is not a pregnant woman, and whose family income is greater than 150 percent but not greater than 200 percent of the poverty line shall pay a premium for coverage under BadgerCare Plus that does not exceed 5 percent of his or her family income.

(b)(1m)#

Except as provided in subd. 4., a recipient who is an adult parent or adult caretaker relative; who is not disabled, pregnant, or American Indian; and whose family income exceeds 133 percent of the federal poverty line shall pay a premium for coverage under BadgerCare Plus in an amount determined by the department that is based on a formula in which costs decrease for those with lower family incomes and that is no less than 3 percent of family income but no greater than 9.5 percent of family income. If the recipient has self-employment income and is eligible under sub. (4) (b) 4., the premium may not exceed 5 percent of family income calculated before depreciation was deducted. If the department intends to impose a premium under this subdivision after December 31, 2013, the department shall request from the federal department of health and human services any necessary approval to continue imposing premiums under this subdivision.

(b)(2)#

Except as provided in subds. 3m. and 4., a recipient who is a child whose family income is greater than 200 percent of the poverty line shall pay a premium for coverage of the benefits described in sub. (11) that does not exceed the full per member per month cost of coverage for a child with a family income of 300 percent of the poverty line.

(b)(3m)#

A recipient who is a child, who is not disabled, and whose family income is at a level determined by the department that is at least 150 percent of the poverty line shall pay a premium in an amount determined by the department. The department may apply this subdivision only to the extent the federal department of health and human services approves applying a premium to those individuals, if approval is required.

(b)(4)#

None of the following shall pay a premium, except as provided in subd. 3m.: a. A child who is a Native American or an Alaskan Native with a family income that does not exceed 300 percent of the poverty line. b. A child who is eligible under sub. (4) (a) 2. or 2m. c. A child whose family income does not exceed 200 percent of the poverty line. d. A pregnant woman whose family income does not exceed 200 percent of the poverty line. e. A child who obtains eligibility under sub. (7) (b) 2. f. An individual who is eligible under sub. (4) (a) 5. g. An individual described in sub. (4) (a) 7.

(b)(4)(a)#

A child who is a Native American or an Alaskan Native with a family income that does not exceed 300 percent of the poverty line.

(b)(4)(b)#

A child who is eligible under sub. (4) (a) 2. or 2m.

(b)(4)(c)#

A child whose family income does not exceed 200 percent of the poverty line.

(b)(4)(d)#

A pregnant woman whose family income does not exceed 200 percent of the poverty line.

(b)(4)(e)#

A child who obtains eligibility under sub. (7) (b) 2.

(b)(4)(f)#

An individual who is eligible under sub. (4) (a) 5.

(b)(4)(g)#

An individual described in sub. (4) (a) 7.

(b)(5)#

If a recipient who is required to pay a premium under this paragraph or under sub. (2m) either does not pay a premium when due or requests that his or her coverage under this section be terminated, the recipient’s coverage terminates. If the recipient is an adult, the recipient is not eligible for BadgerCare Plus for 12 consecutive calendar months following the date on which the recipient’s coverage terminated, except for any month during that 12-month period when the recipient’s family income does not exceed 133 percent of the poverty line. If the recipient is a child, the recipient is not eligible for BadgerCare Plus for 3 consecutive calendar months, or up to 12 consecutive calendar months if the federal department of health and human services approves, following the date on which the recipient’s coverage terminated, except for any month during that period when the recipient’s family income does not exceed 150 percent of the poverty line. This period of ineligibility for a child does not apply to any child who has paid the outstanding premiums.