Wisconsin BadgerCare Insurance Qualifications

BadgerCare is a Medicaid program operated by the Wisconsin Department of Health Services. BadgerCare offers affordable health care for the state's low- to moderate-income families with children. It provides coverage for families without health insurance, those who can’t afford health insurance, those whose employers do not offer family health insurance coverage and those who experience a temporary job layoff or job loss. As a state-run Medicaid program, BadgerCare has some stringent eligibility requirements.

BadgerCare requires that applicants be U.S. citizens and Wisconsin residents. Applicants can submit an application online at Access.wi.gov, by phone, by mail or in person at their county Health and Human Services Department office. The state agency recently simplified its eligibility requirements to provide those in need with more accessible and efficient health care, while also lowering administrative expenses.

To qualify for BadgerCare, a family's income must be below 185 percent of the federal poverty level, or FPL. In February 2014, that income for a family of four was $3,676.88 per month or $44,122.50 per year. BadgerCare also offers special deductions that a family can take from household income that will increase the probability that they will be eligible for benefits. Families that qualify remain eligible for BadgerCare until their income exceeds 200 percent of FPL, or $47,700 for a family of four.

Since the BadgerCare program is geared toward covering low-income and middle-income families, the program also offers more eligibility opportunities for those groups. The program removes the income limits on children, including young people leaving the foster care system. Pregnant women are eligible for BadgerCare if their income is less than 300 percent of FPL, or $67,050 for a family of four. Parents and caretaker relatives are eligible to participate if their income is less than 200 percent of FPL.

Families that meet the eligibility requirements for BadgerCare Plus can apply to participate in the Health Insurance Premium Payment program, or HIPP. Families that participate in BadgerCare are eligible for HIPP if a family member is employed by a company that offers an employer-sponsored health coverage plan that doesn't cover the employee's family. The employer's plan must pay between 40 and 80 percent of the monthly premium costs for the family to be HIPP-eligible. The total cost of coverage for the family, which includes the employee’s contributions to the employer's insurance plan and BadgerCare Plus services not covered by the employer health plan, must also be less than the cost of BadgerCare Plus HMO coverage for the family to be HIPP-eligible.