2016 BadgerCare Plus Eligibility Ending for Members Determined Eligible Under Gap Filling Rules

(News Release) -- This is a reminder that members whose BadgerCare Plus eligibility was determined under gap filling rules during 2016 will lose that eligibility at the end of this year. These members have either already received or will be receiving a letter in the mail about their BadgerCare Plus eligibility ending; they should apply at the Marketplace for 2017 health insurance coverage.

As a reminder, gap filling rules apply when an individual is not eligible for Advanced Premium Tax Credits at the federal Health Insurance Marketplace (based on his or her expected annual income for the year) and is also not eligible for BadgerCare Plus (based on his or her prospective monthly income). Due to the difference in eligibility rules between the Marketplace and BadgerCare Plus, these individuals may fall into a “gap” and require their eligibility for BadgerCare Plus to be re-determined manually.

2016 Coverage

Some gap filling referrals sent from the Marketplace during 2016 are still being processed. Individuals who are still waiting for a BadgerCare Plus eligibility determination for 2016 should apply at the Marketplace for coverage for 2017. For health insurance coverage beginning on January 1, 2017, individuals must apply no later than December 15, 2016. The Marketplace’s Open Enrollment Period for 2017 health insurance coverage ends on January 31, 2017.

2017 Coverage

Applicants who are found ineligible for BadgerCare Plus should apply for 2017 health insurance coverage through the Marketplace at healthcare.gov or by calling 1-800-318-2596 (TTY 711). If an individual who applies for coverage through both BadgerCare Plus and the Marketplace falls into the gap for 2017 coverage, the Marketplace will transfer the application to Wisconsin. The application will have an indicator that the Income Maintenance (IM) agency needs to make a manual BadgerCare Plus determination. The IM agency will then make a BadgerCare Plus eligibility determination for the 2017 calendar year. 

If you have questions about gap filling, email DHS ForwardHealth Partners.