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Updates for local agencies, community-based organizations, and providers who provide assistance to members of Wisconsin's health and nutrition public assistance programs.
Section 1115 BadgerCare Reform Demonstration Waiver Amendment Update
Current Waiver Amendment Status
The Department of Health Services (DHS) and the Centers for Medicare & Medicaid Services (CMS) continue discussions that started in mid-July on the details of the Section 1115 BadgerCare Reform Demonstration Waiver Amendment. As part of these discussions, DHS will be adding a request to the waiver amendment to extend the current Section 1115 BadgerCare Reform Demonstration Waiver. The current waiver expires December 31, 2018, and per CMS regulations, DHS must submit an extension request one year in advance of the waiver expiration. DHS issued notice to tribes on October 30, 2017, to begin the process for requesting the extension. Additional details about the extension request will be posted on the DHS website. This request does not change the amendments for the current waiver amendment application DHS submitted to CMS previously.
Once an agreement is reached with CMS for the waiver amendments and CMS approves the waiver, the effective date of the changes will be at least one year after the approval to inform and work with members, providers, and partners; and to make system enhancements; and implement the changes.
Federal Process for Waiver Amendment
DHS submitted its application to CMS on June 7, 2017, to amend certain provisions of the waiver. The policy amendments, many of which are included in 2015 Wisconsin Act 55, are aimed at bolstering Governor Scott Walker’s efforts to help people move from government dependence to true independence.
On June 15, 2017, CMS sent DHS a letter indicating that CMS completed a preliminary review of the amendment request and determined that it met the requirements for a complete application. As part of the federal review process, CMS held a 30-day federal public comment period from June 15 to July 15, 2017. Public comments that were received are posted on CMS’ Medicaid website.
About the Waiver
The Section 1115 BadgerCare Reform 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. Under Governor Walker’s innovative approach to Medicaid expansion, in 2014 all childless adults at or below 100 percent of the federal poverty level were eligible for coverage under the BadgerCare Plus (Medicaid) standard benefit plan for the first time in Wisconsin history. In addition, the waiver also allows Wisconsin to require a monthly premium for parents and caretaker relatives who qualify for transitional medical assistance.
About the Waiver Amendment
The core changes in the waiver amendment application affect the childless adult population and include the following:
- Establishes monthly premiums and rewards healthy behaviors by lowering premiums for members who make healthy choices. DHS will maintain existing federal copayment and premium exemptions policy for American Indians/Alaska Natives.
- Establishes copayments for emergency department visits to promote appropriate use of health care services and behavior that is mindful of health care value. DHS will maintain existing federal copayment and premium exemptions policy for American Indians/Alaska Natives.
- Implements a work requirement that members work or participate in job skills training at least 80 hours every month to encourage members to seek work and reach self-sufficiency.
- Limits benefits to 48 months, unless a member meets a work requirement or meets an exemption. A list of exemptions is listed on page 11 of the final waiver amendment application.
- Requires members to be screened for drugs and, if necessary, submit to a drug test. Those who test positive will be offered treatment so they can get healthy. Healthy workers help Wisconsin employers fill jobs that require passing a drug test.
- Expands access to treatment by creating a new residential substance use disorder treatment benefit to allow coverage of medically necessary residential substance use disorder treatment services for up to 90 days for all BadgerCare Plus and Medicaid members.
The complete waiver amendment application is available at https://www.dhs.wisconsin.gov/badgercareplus/clawaiver-finalapp.pdf.
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