Yes, you can get BadgerCare Plus even if your employer offers insurance. For adults, employer coverage has no effect on eligibility at all — only your household income matters. For children under 19, employer insurance only comes into play in certain higher-income brackets, and a 2025 rule change narrowed it further so that only a child’s current, active employer coverage counts.
Adults: Only Income Matters
Wisconsin’s BadgerCare Plus Eligibility Handbook exempts everyone age 19 and older from the employer-insurance conditions that apply to children.1Wisconsin Department of Health Services. BadgerCare Plus Eligibility Handbook – Health Insurance Conditions of Eligibility It doesn’t matter whether your employer offers a plan, pays most of the premium, or offers nothing. You can have declined a generous workplace plan and still enroll.
The one test for adults is income. You qualify if your household income is at or below 100% of the federal poverty level.2Wisconsin Department of Health Services. BadgerCare Plus Federal Poverty Level Guidelines For 2026, that works out to:
- $1,330/month for a household of one
- $1,803/month for two
- $2,277/month for three
- $2,750/month for four
Above that line, you won’t qualify regardless of your employer’s plan. Below it, you can enroll regardless of your employer’s plan. That’s the whole adult rule.
This trips people up because earlier versions of the program worked differently, and outdated guidance still floats around. Ignore it. Check your income; the employer question doesn’t apply to you.
Children: When Employer Insurance Can Matter
The rules for kids under 19 have more moving parts. Children can qualify at much higher income levels than adults — up to 306% FPL — and employer coverage only becomes a factor at the top of that range.2Wisconsin Department of Health Services. BadgerCare Plus Federal Poverty Level Guidelines
Under Wisconsin Administrative Code DHS 103.03, employer insurance matters for children in two income tiers:
- Ages 1 through 5, with household income above 191% FPL
- Ages 6 through 18, with household income above 156% FPL
For children in those tiers, eligibility can be affected if the child currently has coverage through a plan where the employer pays at least 80% of the premium and the plan covers services within a reasonable distance from the child’s home.3Wisconsin State Legislature. Wisconsin Administrative Code DHS 103.03 – Non-Financial Conditions for Eligibility Both pieces have to be true: 80%-plus employer contribution and reasonable local access to the plan’s services. If either is missing, the plan doesn’t block eligibility.
Children whose household income falls below the tier thresholds qualify on income alone. The employer-plan test never reaches them.
What Changed in February 2025
Wisconsin used to enforce a “crowd-out” rule meant to stop families from dropping private insurance for the state program. Under those older rules, a child could be disqualified based on recently having had employer coverage, or even just having the ability to enroll in one.
That ended on February 22, 2025. Following new federal regulations that prohibit waiting periods for CHIP-funded coverage, Wisconsin eliminated the look-back at past or future insurance access.4Wisconsin Department of Health Services. DMS Operations Memo 25-03 Only a child’s current, active employer coverage can affect eligibility now. If a child recently lost employer coverage, or a parent chose not to enroll during open enrollment, that history no longer creates a barrier.
Twelve-Month Continuous Coverage for Kids
Once a child under 19 is enrolled, they keep BadgerCare Plus for the full 12-month certification period even if the household’s income or circumstances change mid-year.5Wisconsin Department of Health Services. BadgerCare Plus Frequently Asked Questions The clock starts with the month of the application, the new certification period at renewal, or the date the child first becomes eligible. Enrollment in a new employer plan during the year generally doesn’t cut coverage short; eligibility is re-checked at renewal.
If Your Employer Starts Offering Insurance Mid-Year
Once enrolled, you have 10 days to report changes that could affect eligibility, including a change in insurance status. You can report by phone, in person, or by submitting the Wisconsin Medicaid Change Report (F-10137).6Wisconsin Department of Health Services. Wisconsin Medicaid Change Report F-10137
For adults, gaining access to an employer plan — or even enrolling in one — doesn’t change your BadgerCare Plus eligibility as long as your income stays at or below 100% FPL. For children in the higher-income tiers, actually enrolling in a qualifying employer plan can change eligibility going forward, but the 12-month continuous coverage protection generally carries them to the end of the certification period.
Because employer insurance can matter for certain children, Wisconsin verifies workplace coverage directly with employers through an Employer Verification of Health Insurance process. Your employer may receive a form asking them to confirm whether coverage is available, who can be covered, the total monthly premium, and how the cost splits between employer and employee.7Wisconsin Department of Health Services. Employer Health Insurance Verification Individual Follow-Up Form F-00246 Wisconsin law requires employers to respond, and failure to do so can result in a financial penalty.
If You’re Denied Because of Employer Insurance
If the state denies your application or terminates coverage based on employer insurance — say, by miscounting the employer’s premium contribution or misreading your household income — you can request a fair hearing through Wisconsin’s Division of Hearings and Appeals using the Request for Fair Hearing form (DHA-28).8ForwardHealth. Appealing Enrollment Determinations
Timing is the thing to watch:
- File before your enrollment ends and your coverage continues while the appeal is pending.
- File within 45 days after enrollment ends and you still get a hearing, but coverage is not reinstated during the process.
- File more than 45 days after enrollment ends and you lose the right to a hearing.
The continued-coverage protection vanishes the moment your enrollment officially terminates, so if a termination notice arrives and you plan to challenge it, filing before the end date is what preserves your benefits during the fight.