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1. Except as provided in subd. 2., any individual who is otherwise eligible under this section and who is eligible for enrollment in a group health plan shall, as a condition of eligibility for BadgerCare Plus and if the department determines that it is cost-effective to do so, apply for enrollment in the group health plan, except that, for a minor, the parent of the minor shall apply on the minor’s behalf. 2. If a parent of a minor fails to enroll the minor in a group health plan in accordance with subd. 1., the failure does not affect the minor’s eligibility under this section.
Except as provided in subd. 2., any individual who is otherwise eligible under this section and who is eligible for enrollment in a group health plan shall, as a condition of eligibility for BadgerCare Plus and if the department determines that it is cost-effective to do so, apply for enrollment in the group health plan, except that, for a minor, the parent of the minor shall apply on the minor’s behalf.
If a parent of a minor fails to enroll the minor in a group health plan in accordance with subd. 1., the failure does not affect the minor’s eligibility under this section.
Except as provided in pars. (c), (cg), (cr), (ct), and (d), an individual whose family income exceeds 150 percent of the poverty line is not eligible for BadgerCare Plus if any of the following applies: 1. The individual has individual or family health insurance coverage that is any of the following: a. Coverage provided by an employer and for which the employer pays at least 80 percent of the premium. b. Coverage under the state employee health plan under s. 40.51 (6). 2. The individual, in the 12 months before applying, had access to the health insurance coverage specified in subd. 1. 3. The individual could be covered under the health insurance coverage specified in subd. 1. if the coverage is applied for, and the coverage could become available to the individual in the month in which the individual applies for benefits under this section or in any of the next 3 calendar months.
The individual has individual or family health insurance coverage that is any of the following: a. Coverage provided by an employer and for which the employer pays at least 80 percent of the premium. b. Coverage under the state employee health plan under s. 40.51 (6).
Coverage provided by an employer and for which the employer pays at least 80 percent of the premium.
Coverage under the state employee health plan under s. 40.51 (6).
The individual, in the 12 months before applying, had access to the health insurance coverage specified in subd. 1.
The individual could be covered under the health insurance coverage specified in subd. 1. if the coverage is applied for, and the coverage could become available to the individual in the month in which the individual applies for benefits under this section or in any of the next 3 calendar months.
An unborn child, regardless of family income, is not eligible for BadgerCare Plus if any of the following applies: 1. The unborn child or the unborn child’s mother has individual or family health insurance coverage. 2. The unborn child or the unborn child’s mother, in the 12 months before applying, had access to the health insurance coverage specified in par. (b) 1. 3. The unborn child or the unborn child’s mother could be covered under individual or family health insurance coverage if the coverage is applied for, and the coverage could become available to the unborn child or the unborn child’s mother in the month in which the unborn child applies for benefits under this section or in any of the next 3 calendar months.
The unborn child or the unborn child’s mother has individual or family health insurance coverage.
The unborn child or the unborn child’s mother, in the 12 months before applying, had access to the health insurance coverage specified in par. (b) 1.
The unborn child or the unborn child’s mother could be covered under individual or family health insurance coverage if the coverage is applied for, and the coverage could become available to the unborn child or the unborn child’s mother in the month in which the unborn child applies for benefits under this section or in any of the next 3 calendar months.
An individual who is not disabled and not pregnant, who is over 18 years of age, and whose family income exceeds 133 percent of the poverty line is not eligible for BadgerCare Plus if all of the following apply: 1. The individual has any of the following: a. Access to individual or family health coverage provided by an employer in which the monthly premium that an employee would pay for an employee-only policy does not exceed 9.5 percent of the family’s monthly income. b. Access to individual or family health coverage under the state employee health plan. 2. The individual has access to any coverage described in subd. 1. during any of the following times: a. The 12 months before the first day of the month in which an individual applies for and the month in which an individual applies for BadgerCare Plus. b. The 3 months after the last day of the month in which the individual applies for BadgerCare Plus. c. The month including the date of the annual determination of the individual’s eligibility for Medical Assistance. 3. The individual does not have as a reason for not obtaining health insurance any of the good cause reasons under par. (d) 2. a. to e.
The individual has any of the following: a. Access to individual or family health coverage provided by an employer in which the monthly premium that an employee would pay for an employee-only policy does not exceed 9.5 percent of the family’s monthly income. b. Access to individual or family health coverage under the state employee health plan.
Access to individual or family health coverage provided by an employer in which the monthly premium that an employee would pay for an employee-only policy does not exceed 9.5 percent of the family’s monthly income.
Access to individual or family health coverage under the state employee health plan.
The individual has access to any coverage described in subd. 1. during any of the following times: a. The 12 months before the first day of the month in which an individual applies for and the month in which an individual applies for BadgerCare Plus. b. The 3 months after the last day of the month in which the individual applies for BadgerCare Plus. c. The month including the date of the annual determination of the individual’s eligibility for Medical Assistance.
The 12 months before the first day of the month in which an individual applies for and the month in which an individual applies for BadgerCare Plus.
The 3 months after the last day of the month in which the individual applies for BadgerCare Plus.
The month including the date of the annual determination of the individual’s eligibility for Medical Assistance.
The individual does not have as a reason for not obtaining health insurance any of the good cause reasons under par. (d) 2. a. to e.
1. Subject to subd. 4., an individual who is any of the following is not eligible for BadgerCare Plus if the criteria under par. (cg) 1. and 2. apply to that individual: a. An individual who is not disabled and who is a child, or unborn child, of an individual whose family income is at a level determined by the department but no lower than 133 percent of the poverty line. b. A parent or caretaker relative who is not disabled, not pregnant, and an adult and whose family income is at a level determined by the department but no lower than 100 percent of the poverty line. c. An adult, including a pregnant individual, who is not disabled, who is under 26 years of age; who is eligible to be covered under coverage a parent receives from an employer; and whose family income is at a level determined by the department but no lower than 100 percent of the poverty line. 2. An individual under subd. 1. is not ineligible if any of the good cause reasons described in par. (d) 2. a. to e. is the reason that the individual did not obtain health insurance coverage. 3. An individual under subd. 1. c. is not ineligible if any of the following good cause reasons is the reason the individual did not obtain health insurance coverage: a. The parent of the individual is no longer employed by the employer through which the parent was eligible for coverage, and the parent does not have current coverage. b. The employer of the parent of the individual discontinued providing health benefits to all employees. 4. The department may apply this paragraph to eligibility determinations for BadgerCare Plus only if the federal department of health and human services approves of the conditions to make that individual ineligible, if approval is required.
Subject to subd. 4., an individual who is any of the following is not eligible for BadgerCare Plus if the criteria under par. (cg) 1. and 2. apply to that individual: a. An individual who is not disabled and who is a child, or unborn child, of an individual whose family income is at a level determined by the department but no lower than 133 percent of the poverty line. b. A parent or caretaker relative who is not disabled, not pregnant, and an adult and whose family income is at a level determined by the department but no lower than 100 percent of the poverty line. c. An adult, including a pregnant individual, who is not disabled, who is under 26 years of age; who is eligible to be covered under coverage a parent receives from an employer; and whose family income is at a level determined by the department but no lower than 100 percent of the poverty line.
An individual who is not disabled and who is a child, or unborn child, of an individual whose family income is at a level determined by the department but no lower than 133 percent of the poverty line.
A parent or caretaker relative who is not disabled, not pregnant, and an adult and whose family income is at a level determined by the department but no lower than 100 percent of the poverty line.
An adult, including a pregnant individual, who is not disabled, who is under 26 years of age; who is eligible to be covered under coverage a parent receives from an employer; and whose family income is at a level determined by the department but no lower than 100 percent of the poverty line.
An individual under subd. 1. is not ineligible if any of the good cause reasons described in par. (d) 2. a. to e. is the reason that the individual did not obtain health insurance coverage.
An individual under subd. 1. c. is not ineligible if any of the following good cause reasons is the reason the individual did not obtain health insurance coverage: a. The parent of the individual is no longer employed by the employer through which the parent was eligible for coverage, and the parent does not have current coverage. b. The employer of the parent of the individual discontinued providing health benefits to all employees.
The parent of the individual is no longer employed by the employer through which the parent was eligible for coverage, and the parent does not have current coverage.
The employer of the parent of the individual discontinued providing health benefits to all employees.
The department may apply this paragraph to eligibility determinations for BadgerCare Plus only if the federal department of health and human services approves of the conditions to make that individual ineligible, if approval is required.
1. If the federal department of health and human services approves the department’s request to add private major medical insurance as a type of coverage which causes ineligibility, an individual who is not disabled and not pregnant, who is over 18 years of age, whose family income exceeds 133 percent of the poverty line, and who has coverage provided by private major medical insurance in which the monthly premium does not exceed 9.5 percent of the family’s monthly income is not eligible for BadgerCare Plus. 2. If the federal department of health and human services approves of the conditions to make that individual ineligible for BadgerCare Plus, an individual who is any of the following is not eligible for BadgerCare Plus if he or she has the major medical insurance coverage described under subd. 1.: a. An individual who is not disabled and who is a child, or unborn child, of an individual whose family income is at a level determined by the department but no lower than 133 percent of the poverty line. b. A parent or caretaker relative who is not disabled, not pregnant, and an adult and whose family income is at a level determined by the department but no lower than 100 percent of the poverty line.
If the federal department of health and human services approves the department’s request to add private major medical insurance as a type of coverage which causes ineligibility, an individual who is not disabled and not pregnant, who is over 18 years of age, whose family income exceeds 133 percent of the poverty line, and who has coverage provided by private major medical insurance in which the monthly premium does not exceed 9.5 percent of the family’s monthly income is not eligible for BadgerCare Plus.
If the federal department of health and human services approves of the conditions to make that individual ineligible for BadgerCare Plus, an individual who is any of the following is not eligible for BadgerCare Plus if he or she has the major medical insurance coverage described under subd. 1.: a. An individual who is not disabled and who is a child, or unborn child, of an individual whose family income is at a level determined by the department but no lower than 133 percent of the poverty line. b. A parent or caretaker relative who is not disabled, not pregnant, and an adult and whose family income is at a level determined by the department but no lower than 100 percent of the poverty line.
An individual who is not disabled and who is a child, or unborn child, of an individual whose family income is at a level determined by the department but no lower than 133 percent of the poverty line.
A parent or caretaker relative who is not disabled, not pregnant, and an adult and whose family income is at a level determined by the department but no lower than 100 percent of the poverty line.
1. None of the following is ineligible for BadgerCare Plus by reason of having health insurance coverage or access to health insurance coverage: a. A pregnant woman, except as provided in par. (cr) 1. c. b. A child described in sub. (4) (a) 2. or 2m. c. Except as provided in par. (c), a child who has health insurance coverage, or access to health insurance coverage, as a dependent of an absent parent but who resides outside of the service area of the absent parent’s plan. d. An individual described in sub. (4) (a) 5. e. A child who obtains eligibility under sub. (7) (b) 2., but only for the remainder of the child’s eligibility period under sub. (7) (b) 2. f. An individual described in sub. (4) (a) 7. g. An adult who is disabled. 2. An individual under par. (b) 2., or an individual who is an unborn child or an unborn child’s mother under par. (c) 2., is not ineligible if any of the following good cause reasons is the reason that the individual did not obtain the health insurance coverage under par. (b) 1. to which they had access: a. The individual’s employment ended. b. The individual’s employer discontinued health insurance coverage for all employees. c. One or more members of the individual’s family were eligible for other health insurance coverage or Medical Assistance under s. 49.46 or 49.47 at the time the employee failed to enroll in the health insurance coverage under par. (b) 1. and no member of the family was eligible for coverage under this section at that time or, if one or more members of the individual’s family were eligible for coverage under this section at that time, family income did not exceed 150 percent of the poverty line or the individual qualified for a medical assistance eligibility extension as provided in sub. (4) (a) 7. d. The individual’s access to health insurance coverage has ended due to the death or change in marital status of the subscriber. dg. The insurance is owned by someone not residing with the family and continuation of the coverage is beyond the family’s control. dr. The insurance only covers services provided in a service area that is beyond a reasonable driving distance. e. Any other reason that the department determines is a good cause reason.
None of the following is ineligible for BadgerCare Plus by reason of having health insurance coverage or access to health insurance coverage: a. A pregnant woman, except as provided in par. (cr) 1. c. b. A child described in sub. (4) (a) 2. or 2m. c. Except as provided in par. (c), a child who has health insurance coverage, or access to health insurance coverage, as a dependent of an absent parent but who resides outside of the service area of the absent parent’s plan. d. An individual described in sub. (4) (a) 5. e. A child who obtains eligibility under sub. (7) (b) 2., but only for the remainder of the child’s eligibility period under sub. (7) (b) 2. f. An individual described in sub. (4) (a) 7. g. An adult who is disabled.
A pregnant woman, except as provided in par. (cr) 1. c.
A child described in sub. (4) (a) 2. or 2m.
Except as provided in par. (c), a child who has health insurance coverage, or access to health insurance coverage, as a dependent of an absent parent but who resides outside of the service area of the absent parent’s plan.
An individual described in sub. (4) (a) 5.
A child who obtains eligibility under sub. (7) (b) 2., but only for the remainder of the child’s eligibility period under sub. (7) (b) 2.
An individual described in sub. (4) (a) 7.
An adult who is disabled.
An individual under par. (b) 2., or an individual who is an unborn child or an unborn child’s mother under par. (c) 2., is not ineligible if any of the following good cause reasons is the reason that the individual did not obtain the health insurance coverage under par. (b) 1. to which they had access: a. The individual’s employment ended. b. The individual’s employer discontinued health insurance coverage for all employees. c. One or more members of the individual’s family were eligible for other health insurance coverage or Medical Assistance under s. 49.46 or 49.47 at the time the employee failed to enroll in the health insurance coverage under par. (b) 1. and no member of the family was eligible for coverage under this section at that time or, if one or more members of the individual’s family were eligible for coverage under this section at that time, family income did not exceed 150 percent of the poverty line or the individual qualified for a medical assistance eligibility extension as provided in sub. (4) (a) 7. d. The individual’s access to health insurance coverage has ended due to the death or change in marital status of the subscriber. dg. The insurance is owned by someone not residing with the family and continuation of the coverage is beyond the family’s control. dr. The insurance only covers services provided in a service area that is beyond a reasonable driving distance. e. Any other reason that the department determines is a good cause reason.
The individual’s employment ended.
The individual’s employer discontinued health insurance coverage for all employees.
One or more members of the individual’s family were eligible for other health insurance coverage or Medical Assistance under s. 49.46 or 49.47 at the time the employee failed to enroll in the health insurance coverage under par. (b) 1. and no member of the family was eligible for coverage under this section at that time or, if one or more members of the individual’s family were eligible for coverage under this section at that time, family income did not exceed 150 percent of the poverty line or the individual qualified for a medical assistance eligibility extension as provided in sub. (4) (a) 7.
The individual’s access to health insurance coverage has ended due to the death or change in marital status of the subscriber.
The insurance is owned by someone not residing with the family and continuation of the coverage is beyond the family’s control.
The insurance only covers services provided in a service area that is beyond a reasonable driving distance.
Any other reason that the department determines is a good cause reason.