July 1, 2020, Eligibility Changes for Wisconsin Medicaid and BadgerCare Plus Deductible Plans

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ForwardHealth Community Partners

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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.

July 1, 2020, Eligibility Changes for Wisconsin Medicaid and BadgerCare Plus Deductible Plans

Starting July 1, 2020, there are several eligibility rule changes coming to the BadgerCare Plus and Medicaid Deductible Plans. These plans are for people who have out-of-pocket medical bills and who meet all Medicaid or BadgerCare Plus eligibility rules, except the income limit.

Before these members can get health care benefits, they must meet a deductible. A member’s deductible is the difference between their monthly income and the income limit for getting health care benefits from Medicaid or BadgerCare Plus.

Below is a summary of some of the upcoming changes to these plans.

Deductible Period Start Month for BadgerCare Plus and Medicaid

The deductible period for BadgerCare Plus and Medicaid members is a period of six consecutive months. People who are applying for these plans can choose to begin their deductible period as early as three months before the month of their application. Before July 1, deductible periods could only begin as late as the month of their application. Starting on July 1, deductible periods may begin as late as one month after the month of their application.

Deductible Periods and Excess Assets for Medicaid

Before July 1, a member’s deductible period could not include any months in which that member would be ineligible for the program due to being over the asset limit.

Starting July 1, a member’s Medicaid deductible period may now include months when that member is ineligible due to having assets over the asset limit—as long as the member does not exceed the asset limit in the initial month of their deductible period. For single individuals the asset limit is $2,000, and for married couples the asset limit is $3,000.

Deductible Periods for Children Enrolled in BadgerCare Plus

Starting July 1, a deductible period and deductible amount will be determined for all children who apply for BadgerCare Plus and are eligible for a deductible. All families with children eligible for a deductible will be told the amount of medical expenses needed to meet their child’s deductible.

Income Increases for BadgerCare Plus and Medicaid Members

Before July 1, when a member with an unmet deductible reported an income increase, their deductible amount would also increase. Starting July 1, once a deductible period and deductible amount are established, the deductible amount will not increase during the same deductible period for a member. This includes when a member reports an income increase.

New Letter Informing Members of a Deductible Balance Change

In addition to the changes outlined above, starting July 1, 2020, members who have an unmet deductible will be sent a letter informing them whenever their deductible balance has changed, and what their new balance is.

Members can meet their deductible in any of the following ways:

  • Having medical bills that are equal to or more than their deductible.
  • Prepaying their deductible.
  • Having medical bills that are less than their deductible and prepaying the rest of their deductible.

Members should contact their income maintenance agency to provide proof of their medical bills or make a prepayment.

Deductible-Related Updates to the About Your Benefits Letter

Some updates are being made to the About Your Benefits letter sent to members who are eligible for deductibles, with the goal of making that letter more understandable.

For members eligible for a deductible, after July 1, this letter will now include:

  • The member’s deductible amount.
  • The dates of the member’s deductible period.
  • The names of household members whose medical expenses may be used to meet a deductible.
  • More information about what expenses may be used by a member to meet a deductible and how a member can prepay their deductible if they want to.