BadgerCare Changes for Childless Adults Released for Comment

This week, the Wisconsin Department of Health Services (DHS) released a draft amendment to the current Section 1115 Demonstration Waiver which provides BadgerCare Plus (Medicaid) to adults between the ages of 19-64 who have incomes at or below 100 percent of the federal poverty level (FPL) and do not have dependent children, also referred to as “childless adults.”  DHS will submit the final amendment request to the Centers for Medicare and Medicaid Services for approval on May 26, 2017.

Most of the proposed changes were required by the 2015-2017 biennial budget (Wisconsin Act 55) and include:

  • Monthly Premiums: Establishing monthly premiums of $1 to $10 a month for households with incomes between 21 and 100 percent of the FPL. 
  • Health Risk Assessment: A questionnaire will be used to identify certain health behaviors and risks such as alcohol use, body weight, illicit drug use, seatbelt use, and tobacco use. Premiums may be reduced by half for those who meet certain thresholds set by the department for health risks or healthy behaviors based on responses to the health risk assessment. Those who do not respond to the health risk assessment will pay the full premium.
  • Eligibility Time Limit/Work Requirement: Those between the ages of 19-49 will have a 48-month limit on their eligibility for BadgerCare. After 48 months of enrollment, they will be ineligible for BadgerCare for 6 months. Months during which a member meets a work requirement, or an exemption from a work requirement, do not count towards the 48-month limit. Exemptions from the work requirement include receiving Social Security Disability (SSDI), being physically or mentally unable to work, and being a student.
  • Drug Screening and Testing: Childless adults will be required to complete a drug screening assessment, and a drug test based on the results of the screening. Those who receive a positive drug test will be referred to a treatment program, but will still be eligible for BadgerCare. Those who refuse to participate in a required treatment program will be ineligible for BadgerCare for 6 months.

BadgerCare provides critical access to cancer prevention and treatment services for many Wisconsinites with low-incomes. Ensuring access to these services are priorities of both the WI Comprehensive Cancer Control Plan 2015-2020 and the WI Cancer Council Policy Agenda. It is essential that any changes to BadgerCare take into consideration the experiences of and potential impacts to the over 285,000 cancer survivors throughout the state, many of whom may rely on the program for their care.

DHS is accepting public comment on the proposed changes through May 19th, 2017 and public hearings are scheduled for April 26th (Wausau) and May 1st (Milwaukee). All waiver documents are available on the DHS website, along with an FAQ that will be updated as questions and comments are received.