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Health and Care: Wisconsin:


Wisconsin's BadgerCare Plus Program for Uninsured Families

Overview of the Program

The BadgerCare program was created as a result of federal legislation to provide health coverage for uninsured, low-income children. The federal program, known as The State Children's Health Insurance Program (SCHIP), was passed as Title XXI of the Balanced Budget Act of 1997. Under this program, each state receives a federal block grant and must design a program to deliver health coverage to uninsured children. Federal and state governments share in the costs of this new program, while the states are responsible for administering it. In Wisconsin, state officials determined the best option for enrolling uninsured children was to include their parents and families within the scope of the program.

The purpose of the SCHIP legislation was to insure those children currently excluded from other low-income health programs, like Medicaid, receive health coverage. After the SCHIP program became law, Wisconsin set out to maximize participation and enroll as many children as possible. Program administrators determined that by offering extended coverage to families, the state would maximize the number of uninsured children covered. The incentive for enrollment would be much greater if entire families could benefit, instead of just children. This also simplifies health care options for working families. Instead of having parents with private insurance and their children covered by a government program, a family can receive coverage from a single source. BadgerCare offers the same quality health coverage as Medicaid to low-income families without access to health insurance, and whose incomes exceed Medicaid qualifications.

To qualify for the program:

  • Family income must be below 200% of the federal poverty level ($36,620 for a family of 3). Once enrolled, a family's income can increase to twice the federal poverty rate and stay in the program. This is important to families often not eligible to receive private insurance. They are able to buy into BadgerCare and receive health coverage. Families with disabled children whose incomes are too low to afford health insurance, but too high to qualify for Medicaid can benefit from BadgerCare.

  • Coverage provided by BadgerCare is more extensive than Medicare or private insurance policies. The program pays providers, not consumers, so individuals are not forced to pay for health care costs out of pocket and then wait for reimbursement. BadgerCare and Medicaid pay for services covered by Medicaid, prescription drugs, and any necessary medical equipment. Any payment made by the patient is generally a small co-payment on some services. Additionally, having a pre-existing condition does not prevent individuals from being eligible for BadgerCare, a feature that greatly benefits individuals with disabilities.

    • Health Coverage

    BadgerCare offers the same coverage as Medicaid. If Medicaid covers a procedure, BadgerCare will also cover it. The range of services offered under BadgerCare is extensive. It pays for preventive services (routine doctor visits, prenatal care, preventive checkups, immunizations), vision care, dental care, prescription drugs, family planning services, speech therapy, mental health services, hospital care, lab and x-ray services, hearing services, and any other services covered under Medicaid. Additionally, BadgerCare will pay for costs associated with transportation to receive health services.

    Impact on Individuals with Disabilities

    The fact a program like BadgerCare exists to provide insurance for those who cannot afford it on their own, and do not qualify for programs specifically for the poor is a positive step. Because of programs like BadgerCare, families can buy into a health program and receive coverage that is unavailable from the private sector. Most children with disabilities are considered to have pre-existing conditions, and private insurance companies will usually not cover them. This program allows those families an affordable alternative and provides quality care for those enrolled.

    Health care costs for families with disabled children are typically very high. Insurance often will not cover these families, and most costs have to be paid out of pocket. The financial burden is very high. Other purchases and overall quality of life is reduced for a family because of the staggering medical expenses they are forced to shoulder. This problem is especially difficult for those families whose incomes come from non-professional jobs where they make good wages but do not receive benefits, such as health insurance. BadgerCare gives these families an alternative and reduces the burden health costs place on their budgets.

    How to Apply for BadgerCare

    County/tribal social or human services and W-2 agency staff determine eligibility for BadgerCare. Call (800) 362-3002 with all questions and to find nearest human services location to register for the program.

    To be eligible for BadgerCare:

    Where to apply:

    What to bring:

    Information for this article was compiled from the following sources:

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    [Updated January 31, 2015]
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