Wisconsin submitted its waiver request in June 2017 and it was approved on October 31, 2018.
Wisconsin’s Badger Care reform waiver covers non-pregnant adults without children (19-64) who make less than 100 percent of the federal poverty line, or about $12,000 per year for a single person.
Approved to charge premiums of $8 per household per month for people between 50 and 100 percent of the federal poverty line. Those below 50 percent of poverty would not be charged premiums. As such, a single individual at 50 percent FPL would pay approximately 1.5 percent of their monthly income on premiums. (Higher premiums for individuals covered through Transitional Medical Assistance-TMA.) The state may dis-enroll individuals for failure to pay premiums and subject them to a six month lock out period unless back due premiums are paid. Premium payments may be lowered if individuals complete specified healthy behaviors. Learn more and get advocacy strategies to combat premiums.
BadgerCare enrollees will be required to pay an $8 copay for every time an ED is used for a non-emergency visit. Learn more and get advocacy strategies to combat cost sharing.
Work Requirement & Time Limit
The waiver includes a work requirement for BadgerCare enrollees age 19-49. If enrollees do not report 80 hours/month work or community service after 48 cumulative months of BadgerCare coverage, they will be disenrolled for six months. This will be implemented no sooner than 12 months after approval, which was 10/31/18. Learn more and get advocacy strategies to combat work requirements and time limits.
Wellness Program/Health Risk Assessment
Enrollment is contingent on completion of a Health Risk Assessment with questions on risky health behaviors. The Health Assessment questions were not listed in the approval; however, in the application, Wisconsin stated that they would include questions on alcohol consumption, body weight, illicit drug use, seatbelt use and tobacco use. Enrollees who complete healthy behaviors may have their premiums lowered. Learn more and get advocacy strategies to combat wellness programs.
In its waiver application, Wisconsin asked to condition enrollment on individuals completing a drug screening and, if indicated, enroll in drug treatment. CMS did not approve that. Instead, enrollment is contingent on completion of a Health Risk Assessment that will include questions on drug use. (See above.) Learn more and get advocacy strategies around drug testing.
On December 30, 2013, CMS approved the state’s original BadgerCare Reform waiver to expand Medicaid eligibility to non-pregnant, non-disabled, childless adults with incomes up to 100% of the Federal Poverty Level (FPL). Instead of the enhanced federal medical assistance percentage (FMAP) of 90%, the state receives the regular FMAP. To date, the state has not expanded Medicaid to cover adults with incomes up to 138% FPL and they continue to receive the regular federal match.