Wisconsin Department of Health Services
Section 1115 BadgerCare Reform Demonstration Project Waiver Extension
Overview
The Department of Health Services (DHS) intends to submit an application to the Centers for Medicare & Medicaid Services (CMS) requesting an extension of its Section 1115 demonstration waiver, known as the BadgerCare Reform Demonstration Project Waiver. Wisconsin was authorized to operate the waiver beginning January 1, 2014, through December 31, 2018. DHS is requesting an extension so the state may continue to operate the program beyond the current expiration date.
The Wisconsin BadgerCare Reform Demonstration Project Waiver provides state plan benefits other than family planning services and tuberculosis-related services to childless adults who have family incomes up to 95 percent of the federal poverty level (FPL) (effectively 100 percent of the FPL considering a disregard of 5 percent of income). It permits the state to charge premiums to adults who are only eligible for Medicaid through the transitional medical assistance (TMA) eligibility group (hereinafter referred to as TMA adults) with incomes above 133 percent of the FPL starting from the first day of enrollment and to TMA adults from 100-133 percent of the FPL after the first six calendar months of TMA coverage.
The demonstration permits the state to provide health care coverage for the childless adult population at or below an effective income of 100 percent of the FPL with a focus on improving health outcomes, reducing unnecessary services, and improving the cost-effectiveness of Medicaid services. Additionally, the demonstration has enabled the state to test the impact of providing TMA to individuals who are paying a premium that aligns with the insurance affordability program in the Marketplace based upon their household income when compared to the FPL.
As we move forward, the state continually has a desire to build upon the positive outcomes we have been able to achieve and improve upon the current health care system. As such, in June 2017, DHS submitted a waiver amendment application. These program changes will be included in the waiver extension.
The proposed program changes only pertain to the childless adults’ population unless otherwise stated:
• Establish a monthly premium of $8 for households with incomes from 51 to 100 percent of the FPL.
• Establish lower premiums for members engaged in healthy behaviors.
• Require completion of a health risk assessment.
• Limit a member’s eligibility to no more than 48 months.
• Require, as a condition of eligibility, an applicant or member complete a drug screening and, if indicated, a drug test.
• Charge an $8 copayment for emergency department utilization.
• Establish a work component that allows a member who engages in qualified activities for at least 80 hours a month to not have this time calculated in his or her eligibility time limit.
• Provide full coverage of residential substance use disorder treatment for all BadgerCare Plus and Medicaid members.
Public Comment
Providing information and obtaining input on changes from the public is of high importance for DHS as we prepare to submit the extension request. By law, you have the opportunity to review the official waiver extension application and provide comments for 30 days starting on November 24, 2017, and ending on January 5, 2018. You may also provide comments through written or verbal statements made during public hearings (see below). Public comments will be included in the waiver extension submitted to CMS and will be available on DHS’s website at the address listed below.
Public Hearings
Tuesday, December 5, 2017
10 a.m.–1 p.m.
Pontiac Convention Center
The Regal Room
2809 N. Pontiac Drive
Janesville, WI 53545
Thursday, December 7, 2017
10 a.m.–1 p.m.
Brown County Central Library
Auditorium, Basement Level 1
515 Pine St.
Green Bay, WI 54301
Copies of Waiver Documents
Copies of waiver documents, including the full public notice, which will be posted on November 24, 2017, and the final waiver extension application once complete, may be obtained from DHS at no charge by downloading the documents at www.dhs.wisconsin.gov/badgercareplus/waivers-cla.htm or by contacting Al Matano at: Mail: Al Matano
Division of Medicaid Services
P.O. Box 309
Madison, WI 53707-0309
Phone: 608-267-6848
Fax: 608-266-3205
Written Comments
Written comments on the proposed changes are welcome and will be accepted from November 24, 2017, through January 5, 2018. Written comments may be sent to the Division of Medicaid Services at:
Fax: 608-266-1096
Mail: P.O. Box 309
Madison, WI 53707-0309
