DHS Releases Governor's Plan to Reform Health Care Benefit for Childless Adults

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

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. In 2014, under Governor Scott Walker, for the first time in Wisconsin history, all childless adults at or below 100 percent of the federal poverty level (FPL) were eligible for coverage under the BadgerCare Plus (Medicaid) standard benefit plan.

"These are common sense reforms directed at helping people move from government dependence to true independence through the dignity that is born of work," Governor Walker said. "We believe public assistance should be a trampoline, not a hammock. And so, our message is clear. We are asking able-bodied adults without children, who are on government assistance, to pass a drug test and enroll in job training. If they fail the test, we'll help them get healthy so they can get the job skills they need to get back in the game."

The waiver amendment includes the following changes to coverage for childless adults covered by BadgerCare Plus (Medicaid):

• Implements drug screening: Requires members to be screened for drugs and submit to a drug test, if necessary. Those who test positive will be offered treatment so they can get healthy and get back into the workforce.
• Launches work requirement, time-limited benefits: Benefits are limited to 48 months. Months in which an able-bodied adult, age 19-49, are working or participating in a worker training program are not counted toward the 48-month time limit.
• Establishes monthly premiums of 0 to $10 per household, based on income. This increases the sustainability and value of health care in the state.
• Rewards healthy behaviors by establishing lower premiums: Healthy behaviors are self-assessed through a health risk assessment. Those working toward improving healthy behaviors will be rewarded with lower premiums. The healthy choices include:
  • Wearing a seatbelt
  • Maintaining a healthy weight
  • Not smoking
  • Not abusing or misusing drugs
  • No excessive use or abuse of alcohol
• ​Encourages appropriate emergency room use: Increases copayment for emergency room visits to $8 for the first visit and $25 for subsequent visit to align the program with the private health insurance market and encourages receiving care in the most appropriate place.

“These reforms align with our mission of ensuring our most vulnerable populations have access to health care, while also working to promote healthy living, and further enabling the transition to the workforce for those able to work.” said Medicaid Director Michael Heifetz.

In addition, the draft waiver amendment includes a proposed benefit change for all BadgerCare Plus and Medicaid members, to allow for full coverage of residential treatment for substance use disorder. Expanding treatment for those battling substance abuse is a critical component of our efforts to combat a statewide drug abuse epidemic.