CMS Approves BadgerCare Reform Demonstration Waiver

The federal Centers for Medicare & Medicaid Services (CMS) has approved Wisconsin’s Section 1115 BadgerCare Reform demonstration waiver. The waiver primarily makes changes to the BadgerCare childless adult (CLA) population in the state’s Medicaid program. The changes include:

  • Work requirements. CLAs are required to participate in 80 hours per month of community engagement, including employment, job training, community service, or other work programs.
  • Monthly premiums. CLAs with incomes between 50 and 100 percent of the federal poverty line must pay an $8 monthly premium. Premiums can be adjusted based on healthy behaviors in the health risk assessment (HRA). CLAs can also be charged an $8 copayment for nonemergency emergency room utilization.
  • Health risk assessments. CLAS must complete an HRA in order to be eligible for benefits.
  • Noncompliance eligibility limits. Beneficiaries who have not met eligibility requirements (including community engagement, premiums, and HRAs) for 48 aggregate months will be disenrolled and ineligible to enroll for six months.

The demonstration also includes a substance use disorder program available to all Medicaid beneficiaries that includes coverage for short-term residential treatment services.

CMS declined to approve substance abuse screening requirements the Wisconsin Department of Health Services had requested in its waiver application.

CMS approval extends the BadgerCare Plus program, with these changes incorporated, for five years until Dec. 31, 2023. Gov. Scott Walker said in a press release that final implementation of the changes will not be for at least one year.