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BadgerCare is a public health program created by former Wisconsin Governor Tommy Thompson in 1999. It was created to provide health-care coverage to Wisconsin citizens who could not get it through their employers and who made too much money to use Medicaid. There are several different BadgerCare plans, including BadgerCare Plus, BadgerCare Plus Core and BadgerCare Plus Basic programs.
BadgerCare Plus provides services to a variety of different people, depending on income level and other eligibility factors. Eligible people include pregnant women with an income up to 300 percent of the federal poverty level, all children under 19 years old, parents and caretakers up to 200 percent of the FPL and adults who leave foster care when they turn 18.
BadgerCare Plus Standard
This plan covers a variety of services including chiropractic services, dental services, family planning services, health check for people under 21, hospice care, some home and community-based services, laboratory and X-ray services, medical supplies and equipment, mental health and medical day treatment, optometric services, physician sercies, podiatry services, speech, hearing, and language disorder services, rural health clinic services, and more.
Co-payments for the Standard Plan are between $0.50 and $3.00 depending on the services. If someone uses more than one service, they may have more than one co-payment.
For services up to $10, co-payments are $0.50. From $10.01 to $25.00, co-payment is $1. From $25.01 to $50.00, co-payment is $2. For everything over $50, co-payments are $3.
BadgerCare Plus Benchmark
The Benchmark plan covers many of the same services as the Standard plan, but many are limited or include co-payments for each visit. Some of the services include:
- Chiropractic services, for co-payments of $15 per visit,
- Dental services — Coverage is limited to $750 per year.
- Prescription drugs--Generic drugs only with a co-payment of $5 for each prescription.
- Emergency Room — $60 per visit for non-emergencies. Members do not have to pay this co-payment if they are admitted to the hospital.
- Family Planning Services
- Health Screenings for Children — No co-payment.
- Home Care Services — $15 each visit. Coverage is limited to 60 visits per enrollment year.
- Hospice Care — Co-payment $2 per day. Services are limited to 360 days lifetime.
- Hospital (Includes mental health and substance abuse) — Inpatient co-payments are $100 per stay, $50 for mental health or substance abuse. Outpatient co-payments are $15 for each visit.
Members do not have co-payments if they are a child under 19 years old with a family income up to 100 percent of the FPL, children under six years old with family income up to 150 percent of the FPL, certain children who are Tribal members, certain children enrolled through Express Enrollment and pregnant woman enrolled in BadgerCare Plus Prenatal Services benefit or who are under age 19 with family income above 300 percent of the FPL.
BadgerCare Plus Prenatal
Pregnant women who have a family income up to 300 percent of the FPL can enroll in the BadgerCare Prenatal services program.
Benefits include prenatal care, doctor and clinic visits, dental care, prescription drugs and labor and delivery services.
Pregnant women have no premiums or co-payments under BadgerCare Plus, however pregnant women with income between 200 to 300 percent of the FPL who are insured must keep their insurance. Pregnant women above 300 percent of the FPL must pay a deductible before they can get BadgerCare Plus.
Family Planning Waiver
Women between 15 and 44 years of age can sign up for the family planning waiver, which provides certain contraceptive and other services meant to prevent unwanted pregnancy and sexually transmitted diseases.
The services provided by the waiver include
- Contraceptive services and supplies
- Natural family planning supplies
- Family planning pharmacy visits
- Pap tests
- Tubal ligation
- Tests and treatment for STDs including chlamydia, gonorrhea, herpes and syphilis as well as certain other lab tests
- Routine preventive primary services only if related to family planning.
BadgerCare Plus Core
The Core program was created in conjunction with the expansion of the overall BadgerCare program in 2008. Applications for the program opened in June 2009 and filled so fast that enrollment was capped by Oct.
People were eligible for the Core program if they are not eligible for insurance through the state government, specifically those who have been without health insurance for 12 months and for adults without dependent children.
Coverage through the Core plan includes chiropractic services; disposable medical supplies; doctor visits; hospice and hospital services; emergency services such as visits, ambulance rides and dental; some prescription drugs; physical, occupational and speech therapy; and podiatry.
Some of the major services not covered in the plan include non-emergency dental, hearing services, routine vision exams, inpatient mental health and substance abuse treatment, non-emergency transportation, nursing home care, reproductive health services and services for children and pregnant women.
There is a $60 enrollment fee paid each year when a resident applies or reapplies, as well as co=payments for certain services. The cost of the co-payments varies between two groups: those above 100 percent of the federal poverty line and those between 100 and 200 percent of the federal poverty line.
BadgerCare Plus Basic
Governor Jim Doyle proposed the Basic plan after the Core plan's waiting list became too long due to the recession. It is a temporary, bare-bones plan only for people on the Core waiting list.
The Basic plan would provide limited services such as 10 doctor visits, limited prescription drugs, one inpatient hospital stay and five outpatient visits, five emergency room visits, 10 physical, occupational or speech therapy visits, emergency dental services, limited disposable medical supplies, such as syringes or diabetic pens, emergency ambulance rides, chiropractic services and laboratory and radiology diagnostic services.
The Basic plan would be self-funded with premiums covering the cost of the entire program. Basic members pay a $130 monthly premium, as well as much larger premiums if they exceed those services provided under the original cost.
The State Senate approved the BadgerCare Basic plan Feb. 26, 2010 with a 17-16 vote. All but one Democrat supported the bill and all Republicans opposed it.
- Finance Committee approves BadgerCare
- Senate approves BadgerCare
- Senate Committee passes BadgerCare
- BadgerCare to expand
- Governor announces BadgerCare changes
- State urges new healthplans
- Senate holds hearing
- Governor signs bill
- Senate passes bill