Written by a parent, not a doctor. Nothing here is medical advice.

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Wisconsin program

Health insurance for your child (BadgerCare Plus)

Wisconsin's health insurance for children under 19. It can sit behind insurance you already have.

What it is

Wisconsin's health insurance for children under 19. It can sit behind insurance you already have.

BadgerCare Plus combines Medicaid and CHIP in one application. Your child's income limit is higher than the adult limit. The agency checks the child's household, current income and any existing insurance.

Eligibility rules
  • Children qualify before age 19. Wisconsin uses the child's MAGI household, which may differ from everyone at your address.
  • The test uses current monthly income. Annual income divided by 12 is only an estimate after a pay change.
  • The line by household size, per month (February 2026 to January 2027): 1: $4,070 · 2: $5,518 · 3: $6,967 · 4: $8,415 · 5: $9,863 · 6: $11,312.
  • The tested ceiling is 306% of poverty, including the 5% disregard and 1% conversion factor. These are already included in the dollar limits.
  • A child aged 1 to 5 in a family above about $5,250 a month (four people), or aged 6 to 18 above about $4,290, can be blocked if a parent's employer pays at least 80% of the family premium or offers the state employee plan. Babies and children already in a 12-month coverage period are not affected.
How this can work with your existing insurance
  • Your existing insurance is billed first, with BadgerCare Plus paying second for eligible care.
  • The counselor can check your child's hospital, oncology team, medicines and both plans' billing requirements.
  • HIPP is a separate review of whether Wisconsin can pay the work-plan premium.
  • A hospital or doctor enrolled in Medicaid generally cannot pass your other plan's deductible or copay to you. This covers Medicaid-covered care that meets both plans' approval and billing rules, even when Medicaid pays nothing extra.
What needs a closer look
  • Some children face the current-insurance test described in Eligibility rules. An income screen alone does not settle that test.
  • Keeping both plans can mean two premiums and two sets of coverage rules. Military coverage and out-of-state care need a plan-specific review.
What you get
  • Hospital care, chemotherapy, medicines, dental care and vision care, with no copays for your child's covered care.
  • Most children pay nothing; above about 200% of poverty a child aged 1 to 18 pays $10 to about $98 a month, capped at 5% of income for all the children together.
  • Approved children generally keep coverage for 12 months even if your pay rises.
  • Eligible earlier bills can be covered, subject to separate income limits.
If you decide to apply
  1. Your social worker can help you decide whether to talk with a hospital financial counselor about BadgerCare Plus and temporary Express Enrollment.
  2. Have your child's ID, Wisconsin address, current income, insurance cards and earlier medical bills ready.
  3. Ask the counselor to check which BadgerCare Plus plans your child's oncology team accepts.

ACCESS or your income maintenance or tribal agency; agency referral: 800-362-3002 · Official page ↗

Good to know

Existing insurance is billed first. Some children face an additional insurance test, so having both needs an agency review.

Other details
  • Children aged 1 to 18 pay a premium of $10 to about $98 a month once family income passes about $5,528 a month for four people; babies pay nothing, and all the children together never cost more than 5% of income.
  • During continuous coverage, higher income normally does not start or raise a child's premium. Corrections can apply when earlier eligibility or premium information was wrong. Nonpayment by itself does not end the child's coverage.
  • The ordinary BadgerCare Plus application standard is 30 days, with exceptions when required information or special circumstances delay the decision. Your social worker can help check the filing date and any missing proof. A qualified hospital or other approved entity can start Express Enrollment that day; temporary coverage usually ends at the following month-end or sooner when ongoing coverage is decided, and a timely ongoing application can extend it.
  • Through 2026, earlier coverage can reach up to three months before the application month, subject to age-specific income ceilings. Applications from January 1, 2027 have a two-month look-back, with federal guidance pending.
  • Most children have 12 months of continuous coverage, but Express Enrollment and deductible-based eligibility do not provide that protection. Limited exceptions, such as leaving Wisconsin, turning 19 or correcting an eligibility error, can also change coverage.
  • Home nursing needs a separate clinical review. HealthCheck covers medically necessary care within Medicaid benefit categories for members under 21.
  • With another insurer paying first, an enrolled Medicaid provider generally cannot charge you that plan's deductible, coinsurance or copay for Medicaid-covered care that meets authorization and billing rules, even when Medicaid pays nothing extra. Your social worker or financial counselor can help check both plans' explanations of benefits and any private-pay agreement before treating a bill as your responsibility.
  • A child who is lawfully in the country can qualify without a five-year wait; the agency checks the child's own status, not a parent's. Bills from earlier months are judged against a lower line for older children.
  • A Medicaid health-plan appeal normally has a 60-calendar-day filing window. Decisions normally take 30 calendar days, or 72 hours for an urgent appeal; a justified extension can add up to 14 days. The actual notice identifies the appeal route.
  • A clinic's failure to obtain required prior approval does not, by itself, make covered care your private bill. Noncovered services, valid private-pay agreements and an actual Medicaid deductible have separate rules. Your financial counselor can review the claim before treating it as your responsibility.
  • Illustration only: an employer plan allows $10,000, pays $7,000 and assigns a $3,000 deductible. If Medicaid allows $6,000, it may pay $0 secondarily. For an enrolled provider’s covered claim meeting the billing and approval rules, that $3,000 deductible cannot be passed to the family.
  • If the plan tries to stop a service your child already has, ask in writing within 10 days of the notice to keep it going during the appeal. If you lose, the plan can ask for that cost back.
  • If the plan's appeal fails, the letter tells you how long you have to ask for a state hearing; on some plans it is 90 days, on state-paid Medicaid 45. To keep an existing service running, ask before the change date.

Federal background: Medicaid · CHIP · Medicaid alongside private insurance.

Official sources
Ask your social worker

“Our income looks under the BadgerCare Plus line for our child. What are the benefits and drawbacks of adding it to the insurance we have, and if you think it is worth applying, could you help us?”

Why I’m asking: I want to understand the costs, the insurance rules and whether our child's cancer team takes the plan.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File at access.wi.gov today with this month's income and any insurance. Name the months with old bills and pick a plan the oncology group takes.

Your social worker

The oncology social worker or financial counsellor helps you file, asks the hospital to open Express Enrollment that day, and chases the 30-day notice.

The care team

Nothing for ordinary BadgerCare Plus. Medical records are needed only for the Katie Beckett route.

Who decides
Your local income maintenance or tribal agency checks the income. The Department of Health Services and the BadgerCare Plus health plan you pick run the coverage.
Ask your social worker
“Can you help me apply at access.wi.gov today and ask about Express Enrollment while we wait? Can we list bills from the three months before, and check the hospital and oncology group take the plan?”

How to apply

First step: Apply at access.wi.gov this week, or call 800-362-3002 for your agency. Ask the hospital counsellor today about Express Enrollment, which can open temporary coverage the same day.

  1. Apply at access.wi.gov this week and ask the hospital counsellor for Express Enrollment today.
  2. List the months with bills so the three-month look-back covers the admission.
  3. Pick a BadgerCare Plus health plan that the hospital and the oncology group take.

Official application / program page ↗

Where it starts: Apply at access.wi.gov, or ask the agency. Call 800-362-3002 for the agency covering your address. Ask the hospital's financial counsellor for Express Enrollment the same day.

What to gather

  • Your child's birth certificate or ID and Social Security number
  • Your Wisconsin address
  • This month's income for each adult in the assistance group
  • Insurance cards, if any
  • Hospital bills from the three months before you apply

How long: Written notice is due within 30 days of the agency receiving the application. Express Enrollment through the hospital can start the same day. We found no measured figure for how long decisions actually take.

What a yes looks like

A notice with coverage dates and a ForwardHealth card, plus a choice of health plan. Check the hospital and the oncology group are in that plan before choosing. Then 12 months of continuous coverage.

What a no looks like, and the next move

Check whether the agency said no on income, on a document, or on current insurance. If income is the reason, ask for Katie Beckett Medicaid by name and appeal by the date on the notice.

Watch out

  • The 191% and 156% figures people quote are the insurance test and the look-back line, not the door.
  • Your child can keep private insurance and have this too. Do not cancel a work plan to apply.
  • Above the premium line there is a small monthly charge per child, and not paying it does not end the coverage.

Dates that change this

2026-02-01: Wisconsin puts the new poverty table on BadgerCare Plus on February 1, not January 1. This table runs to January 31, 2027; the next one is not published.

2027-01-01: The state says retroactive coverage drops from three months to two for applications from January 1, 2027, with federal guidance still pending.

2026-12-31: New work rules from December 31, 2026 apply to adults aged 19 to 64 who do NOT have a child under 19 living with them. A parent caring for your child is not in that group.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full BadgerCare Plus coverage. The tested monthly limit is $5,518 for two, $6,967 for three, $8,415 for four, $9,863 for five and $11,312 for six.

  • $5,518.19/month — Household of 2, tested limit (306% of poverty, disregard included)
  • $6,966.61/month — Household of 3, tested limit (306% of poverty, disregard included)
  • $8,415/month — Household of 4, tested limit (306% of poverty, disregard included)
  • $9,863.39/month — Household of 5, tested limit (306% of poverty, disregard included)
  • $11,311.81/month — Household of 6, tested limit (306% of poverty, disregard included)
  • $8,250/month — Household of 4, published base column (300% of poverty, before the disregard)
  • $5,527.5/month — Household of 4, the line above which a child aged 1 to 18 is charged a premium (201% of poverty)
  • $10/month — Smallest monthly premium per child above that line
  • $97.53/month — Largest monthly premium per child, at the top of the range
  • $5/month — Cap on the family's combined children's premiums, as a share of countable income

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Anything medically necessary for a child under 21, through HealthCheck · Nursing and personal care at home when approved · Rides to appointments · Dental and vision

Legal protection: 12 months of continuous coverage for a member under 19, so a pay rise mid-year does not end it · A premium is not a condition of eligibility: if it is not paid the child stays covered · No new or increased premium during the 12-month continuous period

What it costs the family: No premium for a child under 1. Above 201% of the poverty line, $10 to $97.53 a month per child, capped at 5% of countable income.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
MAGI assistance group; the system tests 306% of the poverty line (300% base plus a 5% disregard and a 1% conversion factor, BadgerCare Plus Handbook 16.1.1)
Insurance status condition
Private insurance coexists; it is billed first and Medicaid pays second (Medicaid Eligibility Handbook 9.1.1). A current-insurance test applies above 191% (ages 1-5) and 156% (ages 6-18) where an employer pays at least 80% of the premium or the state employee plan is available; infants are exempt.
Residency
Wisconsin
Continuous eligibility
12 months for members under 19; Express Enrollment and the deductible route are exceptions
Retroactive months
3 now, subject to the age-specific income ceilings; 2 from 2027-01-01
Processing standard
Written notice within 30 days of the agency receiving the application

The trap: The often-quoted 191% and 156% figures are not the door. They are the line for the current-insurance test and for how far back coverage reaches. The door for every child under 19 is the higher limit above. Do not cancel private insurance to apply: private cover is billed first and BadgerCare Plus pays behind it.

Where I read this

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