Non-Financial – 500pts

The __________ ______ code for each individual in the BC+ assistance group indicates

whether the individual is eligible, counted or excluded in that assistance group.

Non-Financial – 500pts

Participation Status

Non-Financial – 600pts

A person must be a WI resident to be eligible for BC+.

What are the two ways the residency requirement is met?

Non-Financial – 600pt

1. Be physically present in WI, and

2. Express an intent to reside.

Non-Financial – 700pts

What is the timeframe to verify citizenship & identity?

Non-Financial – 700pts

90 day reasonable opportunity period, plus 5 days for mailing. (No less than 95 days

total.)

Non-Financial – 800pts

What is Third Party Liability (TPL)?

Non-Financial – 800pts

The obligation that a third party (not BC+), has to pay the bills for a BC+ member’s

medical services. BC+ is the payer of last resort.

Non-Financial – 900pts

The child and that child’s parent can be in the same BC+ test group even when not

living together if either is temporarily absent, provided the continuous absence is

expected to be for no more than months and the caretaker relative

continues to exercise responsibility for the care and control of the child.

Non-Financial – 900pts

six months

Non-Financial – 1000pts

If only one parent of a child is applying for BC+ and he/she is stating that he/she has

placement of the child for at least ____% of the time, accept the declaration unless it is

questionable.

Non-Financial – 1000pts

40%

Health Insurance Access & Coverage – 100pts

Which individuals are subject to health insurance access & coverage policies?

List 2 types.

Health Insurance Access & Coverage – 100pts

 Are children ages 1 - 5 with HH incomes over 191% of the FPL & children ages 6 -

18 with HH incomes over 156% of the FPL,

 Are pregnant women eligible under the BC+ Prenatal Program at any income level,

 Are not in an exempt category &,

 Do not have a good cause reason for failure to enroll in an employer-sponsored

health insurance plan.

Health Insurance Access & Coverage – 300pts

How is past access, current access and/or current coverage for health insurance

verified?

Health Insurance Access & Coverage – 300pts

Employer Verification of Health Insurance (EVHI) database.

Health Insurance Access & Coverage – 400pts

Health insurance access and coverage applies to health insurance policies through

the current employer and where the employer pays % of the premium.

Health Insurance Access & Coverage – 400pts

80% of the premium

Health Insurance Access & Coverage – 500pts

Children under 19 years of age who are ineligible due to current coverage can

become eligible by meeting a____ .

Health Insurance Access & Coverage – 500pts

Deductible

Health Insurance Access & Coverage – 600pts

Which populations are exempt from the policies related to health insurance access &

coverage?

Give 1 example.

Health Insurance Access & Coverage – 600pts

 Infants younger than 1-year-old

 Children younger than 19 with a met deductible

 Children who are in an extension

 Children ages 1 through 5 w/HH income at or below 191% of the FPL,

 Children ages 6 to 18 w/HH income at or below 156% of the FPL

 Former Foster Care Youth

 Pregnant women and pregnant minors, other than those in the BC+ Prenatal

Program

 All adults 19 years old or older

Health Insurance Access & Coverage – 700pts

What does the acronym EVHI stand for?

Health Insurance Access & Coverage – 700pts

Employer Verification of Health Insurance Database

Health Insurance Access & Coverage – 800pts

Name the Wisconsin program that helps BC+ families pay the employee contribution

of their employer-sponsored insurance. This program pays the family’s share of the

monthly premium, co-insurance, and deductibles associated with the family health

plan along with any BC+ covered services not included in the family health plan

plan along with any BC+ covered services not included in the family health plan

through fee-for-service.

Health Insurance Access & Coverage – 800pts

Health Insurance Premium Payment (HIPP) program

Health Insurance Access & Coverage – 900pts

The Past Access test for health insurance looks back ____ months prior to the

application or renewal date.

Health Insurance Access & Coverage – 900pts

12 months

Health Insurance Access & Coverage – 1000pts

Dave applies for BC+ in March for his family. The household is currently at 200% of the

FPL. Dave is currently covered by family health insurance through his employer and

the employer pays 80% of the premium.

Who qualifies for BC+?

Health Insurance Access & Coverage – 1000pts

No one; the kids if they meet a deductible.

Dave does not qualify because he is over 100% of the FPL. The children do not qualify

because they currently have health insurance coverage and their FPL is over 156% &

191% of the FPL, regardless of their ages.

Financial – 100pts

Name 2 of the 6 Pre-Tax Deductions?

Financial – 100pts

1. Health Insurance Premium payments

2. Health Savings Account contributions

3. Retirement contributions

4. Parking & Transit costs

5. Child Care Savings Account contributions

6. Group Life Insurance premium payments

Financial – 200pts

What is the income limit for a pregnant woman?

Financial – 200pts

306% FPL

Financial – 300pts

Sherri is entitled to unemployment compensation of $530/wk. However, she declined

a $100 increase offered by unemployment, and the amount of her check remains

$430.

How much is her available income?

Financial – 300pts

Since the full entitlement amount is known, the available income is $530.

Financial – 400pts

What is the income limit for children under 19?

Financial – 400pts

306% of the FPL;

but really there is no limit, they would be subject to a deductible.

Financial – 500pts

Name 2 of 18 BC+ Tax Deductions?

Financial – 500pts

 Student Loan Interest

 Higher Education Expenses

 Self-employment Tax Deduction

 Spousal support, Alimony or Maintenance

 Teachers’ Tax-deductible expense

 Self Employed SEP, simple or Qualified Plan Contributions

 Penalties for early withdrawal of funds

 Performing Artist tax-deductible expense

 Military Reserve members’ Tax-deductible expenses

 Out of pocket costs for a job-related move

 Loss from sale of business property

 IRA contributions

 Fee-based official tax-deductible expenses

 Domestic Production Activities deduction

 Health Savings Account Deduction

 Self-Employed Health Insurance Deduction

 Allowable write in expenses

 Live-in care provider expenses

Financial – 600pts

How long is a deductible period?

Financial – 600pts

6 months

Financial – 700pts

Name 2 BC+ mandatory verification items.

Financial – 700pts

 SSN

 Citizenship & Identity

 Immigrant status

 Medical expenses (deductible only)

 Proof of Power of Attorney & Guardianship

 Migrant worker’s eligibility in another state

 Income

 Health Insurance Access & Coverage

 Family reunification plan for child welfare parents

 Placement status of a Former Foster Care Youth on their 18th birthday

 Tribal membership or Native American descent

 Pre-tax deductions

 MAGI tax deductions

Financial – 800pts

List one of three types of individuals that can become eligible for BC+ by meeting a

deductible.

Financial – 800pts

1. Children with income over 306% FPL.

2. Children with income above 156% FPL who are ineligible for BC+ solely due to

health insurance coverage and access policies

3. Pregnant women with income above 306% FPL.

NOTE: Deductibles for children are calculated using the amount of income that

exceeds 150% of the FPL & 300% for pregnant women.

Financial – 900pts

What happens when a BC+ premium is not paid?

Financial – 900pts

A Restrictive Re-enrollment Period (RRP) of three months is imposed for children and

non-pregnant, non-disabled adults when a BC+ premium is not paid.

Financial – 1000pts

Name the group of individuals that must pay a BC+ premium.

Financial – 1000pts

Children in families w/income over 201% FPL.

Program Admin – 100pts

BC+ applications must be processed within ____ days of the filing date.

Program Admin – 100pts

Applications must be processed within 30 days of the filing date.

Program Admin – 200pts

A valid application for BC+ must include? (3 items)

Program Admin – 200pts

Name

Address

& Valid Signature

Program Admin – 300pts

List 3 of 6 application methods for BC+.

Program Admin – 300pts

 ACCESS https://access.wisconsin.gov/.

 Mail-In using the BadgerCare Plus Application Packet (F-10182).

 Telephone Interview.

 Face-to-Face Interview.

Use of the paper or online application available through the Marketplace.

 Telephone application with the Marketplace.

Program Admin – 400pts

What is a filing date?

Program Admin – 400pts

The filing date is the day a signed valid application/registration form is delivered to the IM agency.

On an ACCESS application the date that the application is submitted electronically,

regardless of the time of day it was submitted.

Program Admin – 500pts

The begin date for BC+ is effective?

Program Admin – 500pts

BC+ eligibility begins the first day of the month in which a valid application is

submitted and all eligibility requirements are met.

Program Admin – 600pts

Renewals are conducted every____

months, with a few exceptions.

Program Admin – 600pts

12 months

Program Admin – 700pts

Name 1 of the 3 exceptions when BC+ eligibility renewals would not be conducted at

12 months.

Program Admin – 700pts

 Continuously Eligible Newborns (CEN’s) – Renewal is 12 months from DOB.

 Pregnant woman – Renewal is 2 calendar months after the date the pregnancy ends.

 Deductibles – 6mo from the start of the met deductible period.

Program Admin – 800pts

List 4 of 8 non-financial changes that must be reported within ten days of the change.

Program Admin – 800pts

 Address

 Household composition, including pregnancy and changes to the pregnancy of a

BC+ member

 Living arrangement (e.g. institutionalization, incarceration, etc.)

 Change in marital status

 Change in insurance coverage

 Change in expected tax filing status

 Change in tax dependents

 No longer receiving a tax-related deduction

Program Admin – 900pts

When are income changes required to be reported?

Program Admin – 900pts

The income change must be reported by the 10th of the month following the month

in which the total income exceeded its previous threshold.

100% FPL 250% FPL

133% FPL 306% FPL

156% FPL 350% FPL

191% FPL 400% FPL

200% FPL

Program Admin – 1000pts

What are the 2 changes that BC+ FPOS members need to report during the

certification period? These changes must be reported within 10 days of the

occurrence.

Program Admin – 1000pts

 Address or

 Living Arrangement (e.g. incarceration, institutionalization)

Program Coverage – 200pts

What is the age limit to be potentially eligible for Family Planning Services?

Program Coverage – 200pts

 Of childbearing age, and

 Not enrolled in BC+ or receiving other full benefits Medicaid.

Program Coverage – 300pts

An immigrant who is documented but has not been in the US for 5 years or more, or

an undocumented immigrant may be eligible for which limited BC+ benefit?

Program Coverage – 300pts

Emergency Services

Program Coverage – 400pts

Minor members applying for or receiving this benefit will have all eligibility

information kept confidential from parents or guardians unless the member gives

consent.

Name this program.

Program Coverage – 400pts

Family Planning Only Services

Program Coverage – 500pts

Which 2 groups of individuals does the BC+ Prenatal program provide coverage for?

Program Coverage – 500pts

 Inmates of a public institution

 Non-qualifying immigrants

Program Coverage – 600pts

What is the Pharmacy Services Lock-In Program?

Program Coverage – 600pts

Members enrolled in this program are assigned to one primary care provider and one

pharmacy to reduce unnecessary physician and pharmacy utilization and to

discourage the non-medical or excessive use of prescription drugs. Members remain

enrolled for 2 years and are continuously monitored for their prescription drug usage.

Program Coverage – 700pts

What happens if a BC+ member lives in an area where it is mandatory s/he picks an

HMO and s/he does not choose one?

Program Coverage – 700pts

The member will be assigned an HMO and will also receive another HMO enrollment

form with the choice to change the HMO that was selected for them within 3 months.

Program Coverage – 800pts

How long is an individual locked into an HMO?

Program Coverage – 800pts

The member has up to 3 months to change HMO’s, once enrolled (this is the open

enrollment period). After the initial three months, the member is locked into the HMO

and can not change for nine months.

Program Coverage – 900pts

What does BC+ emergency services cover?

Program Coverage – 900pts

 Medical services needed for the treatment of an emergency medical condition.

 All labor and delivery services for eligible non-qualifying immigrants.

Program Coverage – 1000pts

List the 2 of the 4 limited coverage programs available through BC+.

Program Coverage – 1000pts

1. Emergency Services

2. FPOS

3. BC+ Prenatal Services

4. Tuberculosis-Related Services