Contact(s): Tom Evenson, (608) 266-2839
Julie Lund, (608) 266-1683

Madison, WisconsinThe Wisconsin Department of Health Services (DHS) submitted an application to the Centers for Medicare and Medicaid Services (CMS) today requesting an amendment to certain provisions of the Section 1115 Demonstration Waiver, known as the BadgerCare Reform Demonstration Waiver. The policy amendments, many of which are included in 2015 Wisconsin Act 55, are aimed at bolstering Governor Scott Walker’s efforts to help people move from government dependence to true independence.

“Wisconsin Works for Everyone is about helping people transition from public assistance into Wisconsin’s workforce, where they can build a solid financial foundation for themselves and their families,” Governor Walker said. “Unemployment is low, and the percentage of people working in Wisconsin is among the best in the nation. This application is a step in the right direction, and we’re continuing to build on Wisconsin’s legacy as a leader in welfare reform.”

The core changes in the waiver amendment application affect the childless adult population and include the following:

  • Establishes monthly premiums and copayments for emergency department visits.
  • Implements a work requirement that members work or participate in job skills training at least 80 hours every month.
  • Limits benefits to 48 months, unless a member meets a work requirement.
  • Rewards healthy behaviors by establishing lower premiums for members who make healthy choices.
  • Requires members to be screened for drugs and if necessary, submit to a drug test. Those who test positive will be offered treatment so they can get healthy. Healthy workers help Wisconsin employers fill jobs that require passing a drug test.
  • Expands access to treatment by creating a new residential substance use disorder treatment benefit to allow coverage of medically necessary residential substance use disorder treatment services for up to 90 days for all BadgerCare Plus and Medicaid members.

Following the release of the draft Section 1115 Demonstration Waiver amendment application in April, DHS gathered feedback, including more than 1,000 submitted comments, and made the following revisions due to comments from Wisconsin citizens:

  • For premiums, there will be two income tiers instead of four. Childless adults with household incomes of zero to 50 percent of the federal poverty level (FPL) will not pay a premium, and those with household incomes of 51 to 100 percent of the FPL will pay an $8 monthly premium.
  • The emergency department copayment for childless adults will be $8 for each visit. The original draft application had an $8 copayment for the first visit to the emergency department and a $25 payment for each subsequent visit in a 12-month period.
  • If a member refuses to consent to substance use disorder treatment, instead of being ineligible for BadgerCare Plus benefits for six months, an individual may reapply at any time he or she consents to the treatment.
  • A drug test will not be required for childless adults who indicate on their drug screening assessment that they are ready to enter a substance use disorder treatment program. Members may be required to take a drug test as part of their substance use disorder treatment.

Once CMS receives the complete application, a 30-day federal public notice process begins along with a 45-day minimum federal decision-making period. During this time, DHS will work with CMS to finalize the details of the waiver. Once the changes to the waiver are approved by CMS, the effective date of the changes will be at least one year after approval to inform and work with members, providers, and partners, and to make system enhancements and implement the changes.

The 1115 Demonstration Waiver allows Wisconsin to offer the BadgerCare Plus (Medicaid) standard benefit plan to adults without dependent children, ages 19-64, also known as the “childless adult” population. Under Governor Walker’s innovative approach to Medicaid expansion, in 2014 all childless adults at or below 100 percent of the federal poverty level (FPL) became eligible for coverage under the BadgerCare Plus (Medicaid) standard benefit plan for the first time in Wisconsin history.

Learn more about the BadgerCare Reform Demonstration Waiver here.

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