DHS Releases Proposed Medicaid Waiver

The Department of Health Services (DHS) recently released a waiver for public comment that would make changes to the state Medicaid program. DHS intends to submit the Section 1115 Demonstration Waiver or “BadgerCare Reform Demonstration Waiver” to the federal Centers for Medicare and Medicaid Services (CMS) for review on May 26.

The proposed changes will mostly affect the BadgerCare Plus childless adult (CLA) population. Currently, BadgerCare Plus provides coverage for CLA households up to 100 percent of the federal poverty level. The waiver includes the following changes to the program:

  • Substance abuse screening and drug testing. Under the change, individuals will be required to complete a drug screening assessment and some will be required to take a drug test. If individuals test positive for illegal substances, they can either enter substance abuse treatment or be ineligible for Medicaid for six months. Individuals that refuse to have the assessment or drug test will lose Medicaid benefits until they do so.
  • Monthly Premiums. Monthly premiums will be established for CLAs, ranging from $1 to $10 depending on the household income. The proposal exempts households with income between 0 and 20 percent of the federal poverty level from the premiums.
  • Healthy behavior incentives. Those who practice healthy behaviors, determined by a Health Risk Assessment questionnaire, would have the opportunity to have their premiums reduced by 50 percent.
  • 48-month eligibility limit. Members will be limited to 48 months of Medicaid eligibility unless they are working or participating in a job training program. Individuals with mental illness, disability and full-time students are exempt from the time limit.

DHS says the proposed changes strengthen Wisconsin’s Medicaid program and encourage people to get substance abuse treatment and job training. Critics say the changes push people off Medicaid, thereby increasing uncompensated care costs.

DHS held a public hearing on the proposed changes on April 26 in Wausau. DHS Medicaid Director Michael Heifetz gave a presentation on the waiver amendments, followed by public questions and comments. Another public hearing will be held on May 1 in Milwaukee.

The comment period on the waiver is for 30 days starting on April 19, 2017, and ending on May 19, 2017.

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