DHS 103.085(3)(a)(a) Period of ineligibility. A BadgerCare Plus group that fails to make a premium payment under sub. (1) is not eligible for BadgerCare Plus for a period of at least 3 consecutive calendar months following the date that BadgerCare Plus eligibility ends, unless one of the circumstances in par. (b) applies. Eligibility is restored as described in par. (c). After 3 calendar months, the child shall be eligible for BadgerCare Plus if otherwise eligible. DHS 103.085(3)(b)(b) Reasons restriction on re-enrollment may not apply. The restriction on re-enrollment under this section does not apply for any of the following reasons: DHS 103.085(3)(b)1.1. The failure to pay premiums was due to a circumstance beyond the group’s control, provided that all past due premiums have been paid in full. A circumstance beyond the group’s control includes any of the following: DHS 103.085(3)(b)1.a.a. A problem with an electronic funds transfer from a bank account to the BadgerCare Plus program. DHS 103.085(3)(b)3.3. Payment is received in full for all owed premiums before the end of the three-month restrictive re-enrollment period. DHS 103.085(3)(b)4.4. Any other circumstance affecting payment of the premium which the department determines is beyond the group’s control, but not including insufficient funds. DHS 103.085(3)(c)(c) Resuming BadgerCare eligibility. Eligibility for BadgerCare shall resume in the following manner for persons with a re-enrollment restriction that ended due to a reason described in par. (b): DHS 103.085(3)(c)1.1. For a child with a reason under par. (b) 1. for the re-enrollment restriction not to apply, BadgerCare Plus eligibility shall be restored for any months that the group had been closed during the restriction period, provided that payment of any outstanding premiums owed is made and the child was otherwise eligible for BadgerCare Plus in those months. DHS 103.085(3)(c)2.2. For a child with a reason under par. (b) 3. for the re-enrollment restriction not to apply, BadgerCare Plus eligibility shall be restored for any calendar months that the child’s BadgerCare Plus fiscal test group’s income was at or below 201% of the poverty line and the child was otherwise eligible for BadgerCare Plus in those months. DHS 103.085(3)(c)3.3. For a child with a reason under par. (b) 4. for the re-enrollment restriction not to apply, BadgerCare Plus eligibility shall be restored for all months that the child had been ineligible during the restriction period, provided that payment of any outstanding premiums owed is made and the child is otherwise eligible for BadgerCare Plus in those months. DHS 103.085 HistoryHistory: Emerg. cr. eff. 7-1-99; cr. Register, March, 2000, No. 531, eff. 4-1-00; correction in (5) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 20-039: renum. (3) (b) (intro.) and 1. to (3) (b) (intro.) and am., r. (3) (b) 2., (6) Register October 2021 No. 790, eff. 11-1-21; CR 23-046: am. (title), (1) (a), (b) 1. to 4., cr. (1) (b) 5., am. (1) (c), r. and recr. Table 103.085, cr. (1) (cm), am. (1) (d) 1., r. (1) (d) 5., am. (1) (e) (intro.), r. (1) (e) 1., am. (1) (e) 2., (f), r. (2), am. (3) (a), (b) (intro.), r. and recr. (3) (b) 1. to 3., am. (3) (c) 1., r. and recr. (3) (c) 2. cr. (3) (c) 3., r. (4), (5) Register April 2024 No. 820, eff. 5-1-24; correction in (1) (c) made under s. 35.17, Stats., Register April 2024 No. 820. DHS 103.087DHS 103.087 Conditions for continuation of eligibility. DHS 103.087(1)(a)(a) Authority. Subject to this section and s. 49.472, Stats., a person eligible for the medicaid purchase plan shall pay a monthly premium. DHS 103.087(1)(b)1.1. An applicant or recipient eligible for the medicaid purchase plan whose total earned and unearned income is above 100% of the poverty line for the applicable household size shall pay a monthly premium and the applicant shall pay all retroactive premium amounts assessed or other premium payments due. DHS 103.087(1)(b)2.2. An applicant or recipient eligible for the medicaid purchase plan whose total earned and unearned income is at or below 100% of the poverty line for the applicable household size pay does not owe a monthly premium. DHS 103.087(1)(c)1.1. An applicant or recipient eligible for the medicaid purchase plan shall pay a monthly premium in accordance with this subsection. DHS 103.087(1)(c)2.2. The county agency shall determine the amount of the premium an applicant shall pay according to the guidelines described in this subsection at the time of application. DHS 103.087(1)(c)3.3. All earned and unearned sources of income available to the applicant or recipient, except for the interest, dividends or other gains accrued from a recipient’s independence account, shall be used in the premium determination. DHS 103.087(1)(d)(d) Calculating the monthly adjusted earned and unearned income. An applicant’s or recipient’s monthly adjusted income shall be calculated by subtracting applicant’s or recipient’s gross monthly countable earned and unearned income, their actual out-of-pocket medical and remedial expenses, long-term care costs, and impairment-related work expenses. DHS 103.087(1)(f)1.1. An applicant or recipient shall pay 3 percent of his or her adjusted earned and unearned monthly income under par. (d) that is in excess of 100 percent of the poverty line plus $25.