MedicaidCoverageHigh impact
BadgerCare Plus Postpartum Coverage Period Extended to 12 Months
Wisconsin Medicaid (ForwardHealth)·WI · OB-GYN, Family Medicine, General Practice +1 more·Medical Policy
Effective date
Jun 1, 2026
We identified it
Aug 26, 2026
Summary
BadgerCare Plus postpartum coverage has been extended from 60 days to 12 months (365 days) effective June 1, 2026. Members whose pregnancies ended between January 1–May 31, 2026, are retroactively eligible for the extended coverage. Prenatal Care Coordination (PNCC) benefits are also extended to 12 months, and providers may retroactively bill back to March 1, 2026, for PNCC services.
Action Required
By June 1, 2026: Billing team must update claim processing workflows to recognize 12-month postpartum coverage periods for BadgerCare Plus members instead of the previous 60-day window. Update system edits and eligibility verification tools to reflect new coverage end dates. For members with pregnancy end dates January 1–May 31, 2026, manually verify retroactive coverage reinstatement requests and process claims back to March 1, 2026, for PNCC services. Front desk staff must instruct members to contact their income maintenance agency to report pregnancy end dates if not already reported. Verify that billing software correctly calculates coverage end dates through the end of the month containing the 365th day after pregnancy ends (e.g., pregnancy ending April 14, 2026 = coverage through April 30, 2027). Failure to recognize extended coverage will result in claim denials and may require recoupment of improperly denied payments.