DHS 103.03(1)(f)3m.c. c. The health insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.

DHS 103.03(1)(f)3m.d. d. The health insurance policy is through the mother’s employer or the employer of the mother’s spouse when the spouse is residing with the mother.

DHS 103.03(1)(f)3m.e. e. When the mother is under 19 years old, the health insurance coverage is through the employer of the mother’s parent, step-parent, or other caretaker relative residing with the mother.

DHS 103.03(1)(f)4. 4. Except as provided in subd. 5. or 5m., if the person did not, at any time in the 12 months immediately preceding application for BadgerCare Plus, have access to employer-subsidized health care coverage or a state employee health plan and is any of the following:

DHS 103.03(1)(f)4.a. a. A child ages 1 through 5 with household income over 191% of the federal poverty level.

DHS 103.03(1)(f)4.b. b. A child ages 6 through 18 with household income over 156% of the federal poverty line.

DHS 103.03(1)(f)4g. 4g. The child under subd. 4. is ineligible for BadgerCare Plus the first day of the month that the employer’s plan would have provided coverage for the child if the family had been enrolled in the plan. The child remains ineligible for each month that coverage would have been available up to 18 12 months from the month the failure to enroll in the plan occurred if the health insurance plan meets all of the following criteria:

DHS 103.03(1)(f)4g.a. a. The health insurance coverage is provided by an employer that pays 80% of the premium or coverage is available under the state of Wisconsin employee health plan.

DHS 103.03(1)(f)4g.b. b. The health insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.

DHS 103.03(1)(f)4g.c. c. The health insurance policy is through the child’s employer, the employer of the child’s spouse when the spouse is residing with the child, or the employer of the child’s parent, step-parent or other caretaker relative residing with the child.

DHS 103.03(1)(f)4r. 4r. Except as provided in subd. 5., if the person is an unborn child, the unborn child’s mother did not, at any time in the 12 months immediately preceding application for BadgerCare Plus, have access to employer-subsidized health care coverage, or a state employee’s health plan. The unborn child is ineligible for BadgerCare Plus the first day of the month that the employer’s plan would have provided coverage for the unborn child’s mother if the family had been enrolled in the plan. The unborn child remains ineligible for each month that coverage would have been available up to 12 months from the month the failure to enroll in the plan occurred if the health insurance plan meets all of the following criteria:

DHS 103.03(1)(f)4r.a. a. The health insurance coverage is provided by an employer that pays 80% of the premium or coverage is available under the state of Wisconsin employee health plan.

DHS 103.03(1)(f)4r.b. b. The health insurance covers services provided in a service area that is within a reasonable driving distance from the person’s residence.

DHS 103.03(1)(f)4r.c. c. The health insurance policy is provided through the mother’s employer, the employer of the mother’s spouse when the spouse is residing with the mother, or the employer of the mother’s parent, step-parent or other caretaker relative residing with the child, if the mother is under 19 years of age.

DHS 103.03(1)(f)5. 5. The 12 month period in subds. 4. and 4m. does not apply if one of the following statements is true about access to employer-subsidized health care coverage:

DHS 103.03(1)(f)5.a. a. The employment ended.

DHS 103.03(1)(f)5.b. b. The person’s employer discontinued health care coverage for all employees.

DHS 103.03(1)(f)5.c. c. A member or members of the family were eligible for other health insurance coverage or MA at the time the employee failed to enroll in the employer-subsidized health care coverage and no member of the group was eligible at that time for BadgerCare Plus with an assistance group income above 156% of the federal poverty line.

DHS 103.03(1)(f)5.e. e. Any other reason determined by the department to be a good cause reason.

DHS 103.03(1)(f)6. 6. The person is not eligible for MA under BadgerCare Plus-related or SSI-related criteria in this chapter.

DHS 103.03(1)(f)7. 7. A person required to pay a premium under s. DHS 103.085 (1) has made the first payment.

DHS 103.03(1)(f)8. 8. A person has not chosen to receive BadgerCare Plus-related or SSI-related MA through a spend-down, as described in s. DHS 103.08 (2) (a), or has chosen to end a spend-down period at any time prior to the date at which the expenditure or obligation of excess income has been achieved.

DHS 103.03(1)(fm) (fm) Exemption from health insurance coverage requirements. A child is exempt from the health insurance coverage requirements in sub. (1) (f) 2., 3., and 4., if they meet any of the following criteria:

DHS 103.03(1)(fm)1. 1. The child is younger than 19 years old, has met a deductible, and is in the deductible period.

DHS 103.03(1)(fm)2. 2. The child is in an extension.

DHS 103.03(1)(fm)3. 3. The person is age 18 and was in foster care, subsidized guardianship, or court-ordered kinship care on the date they turned 18 years old.

DHS 103.03(1)(fm)4. 4. The child is pregnant.

DHS 103.03(1)(g) (g) Medicaid purchase plan non-financial eligibility. To be non-financially eligible for the medicaid purchase plan a person shall meet the conditions described in par. (c) for SSI-related persons and shall be age 18 or older and the person shall meet any of the following conditions:

DHS 103.03(1)(g)1. 1.