The Department of Health Services (DHS) submitted the “BadgerCare Reform Demonstration Waiver” to the federal Centers for Medicare and Medicaid Services (CMS) Wednesday for review. The waiver essentially amends the Section 1115 Demonstration Waiver and would primarily make changes to the BadgerCare childless adult (CLA) population in the state’s Medicaid program. The changes include substance abuse screening and drug testing, monthly premiums, healthy behavior incentives and a 48-month eligibility limit.

DHS released a draft of the waiver for public comment in April. After public hearings and over 1,000 submitted comments, DHS made the following revisions:

• For monthly premiums, there will be two tiers depending on household, instead of four. CLAs with household incomes zero to 50 percent of the federal poverty level will not pay premiums. CLAs with incomes 50 to 100 percent of the federal poverty level will pay an $8 monthly premium.
• The emergency department copayment for CLAs will be $8 for each visit instead of the $8 first-time charge and $25 charge for subsequent visits in a 12-month period.
• If a BadgerCare member refuses substance abuse treatment, they can reapply for the program as soon as they consent to treatment, instead of being ineligible for six months.
• Drug testing will not be required for CLAs who indicate on their screening questionnaire they are ready for substance abuse treatment.

Once CMS receives the application, CMS will begin a 30-day federal public notice process and a 45-day minimum federal decision-making period. DHS will work with CMS to finalize the waiver and inform and work with members, providers and partners to implement the changes. The effective date will be at least one year after approval.

On May 25, the Joint Finance Committee (JFC) approved the submission of the waiver as a part of the DHS’ omnibus motion. Despite the approval, the motion provided JFC with additional oversight after the waiver is approved by CMS. Under the motion, DHS must submit a report to JFC after its approval, providing JFC with an opportunity to approve the final CMS-approved waiver once again before DHS moves forward with implementation. Furthermore, the motion provided JFC with the ability to make modifications to the final waiver, which would then require DHS to go back to CMS for another review. The budget motion with this oversight provision passed out of JFC, but could be a veto target once the budget makes its way to the governor.