DHS Submits Application to Reform BadgerCare Plus for Childless Adults

The Wisconsin Department of Health Services (DHS) has submitted an application to the Centers for Medicare and Medicaid Services (CMS)  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.

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.