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Updates for local agencies, community-based organizations, and providers who provide assistance to members of Wisconsin's health and nutrition public assistance programs.
Premium Payment Assistance is Available for Childless Adults in BadgerCare Plus
In fall 2019, the Wisconsin Department of Health Services (DHS) announced that per Wis. Stat. §20.940(3)(c)(2) there would be changes to BadgerCare Plus benefits for adults ages 19 to 64 who do not have children living at home. Changes include:
- Monthly premiums (depending on income)
- An optional health survey to help lower monthly premiums
- A mandatory treatment needs question
- An emergency room copay for non-emergency visits. However, members are exempt from paying copays until July 1, 2020, in order for Wisconsin Medicaid to comply with federal cost share requirements.
These new rules begin on February 1, 2020.
Some childless adults will now have to pay premiums of up to $8 a month in order to maintain BadgerCare Plus coverage. DHS understands that there may be times when a member is unable to make monthly premium payments. The BadgerCare Reform 1115 demonstration waiver allows DHS to provide a process by which third party contributors can make a donation to DHS for the purpose of helping BadgerCare Plus childless adult members pay their monthly premiums.
Premium Payment Assistance for BadgerCare Plus Childless Adult Members
If BadgerCare Plus childless adult members cannot pay their monthly premiums, encourage them to contact the Member Services Premium Line at 1-888-907-4455 to request assistance with covering the cost of their monthly premium.
The following people can request premium assistance:
- The member
- The member's spouse
- The member's authorized representative
- The member's financial power of attorney
- The member's legal guardian over the estate
- Someone else authorized by the member
When requesting premium assistance, the caller will need to provide:
- The caller's full name (if not the member)
- The member's full name
- The member's ForwardHealth ID, Social Security Number, or case number
- The member's date of birth
Those who qualify will have unpaid BadgerCare Plus premiums paid in full from donations in the BadgerCare Plus Childless Adult Premium Fund. Their future premiums may also be paid until their next renewal, if funds are available. Members will receive a letter confirming that their premiums are being paid by this program. DHS does not guarantee that funds will be available to cover requests for premium assistance.
Before asking for assistance, members can also complete the optional health survey, which may lower their monthly BadgerCare Plus premium. The optional health survey can be completed by using one of the following methods:
Resources
Partners who have questions about this process can email dhswisconsin1115clawaiver@dhs.wisconsin.gov. While emails will not be responded to individually, DHS will be monitoring the questions and updating communications, including the FAQs, as applicable.
Members who have questions about the upcoming rule changes can be directed to call ForwardHealth Member Services at 800-362-3002, Monday through Friday, from 8 a.m. to 6 p.m.
Information about the rule changes is available on the Wisconsin DHS website at www.dhs.wisconsin.gov/badgercareplus/changes-stakeholders.htm.
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