Upcoming BadgerCare Plus Program Changes for Certain Adults

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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.


Upcoming BadgerCare Plus Program Changes for Certain Adults

Background

BadgerCare Plus applicants and members ages 19 to 64 who are not pregnant and do not have dependent children under the age of 19 living in their home may be affected by some upcoming BadgerCare Plus program changes. (These individuals are referred to as childless adults.) The changes include an emergency room copay, monthly premiums, and a treatment needs question.

The changes are being made as part of the Section 1115 BadgerCare Reform demonstration waiver amendment that the Centers for Medicare & Medicaid Services approved in October 2018. This waiver allows Wisconsin to provide Medicaid coverage to childless adults.

Emergency Room Copay

Starting February 1, 2020, most BadgerCare Plus childless adults must pay an $8 copay for receiving services in the emergency room when it is not an emergency.

Hospitals are responsible for determining whether an individual’s condition meets the definition of an emergency. If it does not and the individual chooses to receive services in the emergency room, then hospitals are responsible for charging that individual the $8 copay.

Note: While Wisconsin works to comply with federal cost share rules, copays for services provided to BadgerCare Plus and Medicaid members have been temporarily stopped for services provided from January 1, 2020, through June 30, 2020.

Monthly Premiums

Most BadgerCare Plus childless adults whose monthly income is above 50% of the federal poverty level must pay a monthly premium to be eligible for BadgerCare Plus. This means that single individuals with monthly income of more than $531.67 would pay a monthly premium, and married individuals with monthly income of more than $718.34 would pay a monthly premium.

Monthly premiums will start at $8; however, members can lower their monthly premiums by taking an optional health survey and showing they have healthy habits, have a health condition that keeps them from participating in healthy habits, or are managing their health risks. Members can take the survey through the ACCESS website, the MyACCESS mobile app, a paper form, or phone.

Members will be able to pay their premium by:

  • Credit card, debit card, checking account, or savings account through the ACCESS website or MyACCESS mobile app.
  • Mailing a check or money order.

Monthly premiums will apply to new applicants starting February 1, 2020, and to current members when they next renew their benefits for renewals due on or after March 31, 2020.

If members need to pay a monthly premium, they will receive a letter with their premium amount and information on how to lower their premium if they have not lowered it already. Members will also receive this letter any time their premium amount changes. (For example, they take the health survey and lower their monthly premium from $8 to $4.)

In addition, members will receive a monthly premium statement that will list their monthly premium and the total amount they owe. Members will be charged a premium each month; however, they do not have to pay each month. They can pay at any time as long as it is before their yearly renewal or before their BadgerCare Plus coverage ends. If they don’t pay the total amount owed at this time, they may not be able to get BadgerCare Plus benefits for six months. They will receive a letter asking them to pay any outstanding premiums prior to their not being able to get BadgerCare Plus benefits.

Treatment Needs Question

Most BadgerCare Plus childless adults must answer a treatment needs question when they apply for or renew their BadgerCare Plus benefits to be eligible for BadgerCare Plus. The treatment needs question asks if they have used drugs in the last 12 months in ways that cause problems for them or those around them and if they are open to getting help.

If it applies to them, new applicants must answer the treatment needs question starting February 1, 2020. Applicants who apply using the ACCESS website or by calling their agency can answer the question right then. If they choose not to answer at that time or apply by paper, they will receive a letter asking them to answer the question. They can then answer through the ACCESS website, the MyACCESS mobile app, a paper form, or phone with their agency.

If it applies to them, current members must answer the treatment needs question when they next renew their benefits for renewals due on or after March 31, 2020:

  • Members whose benefits are renewed based on information on file and obtained from data exchanges will receive information about the treatment needs question in the letter they receive when their benefits are renewed. They can answer the question through the ACCESS website or the MyACCESS mobile app, by completing and returning the paper form included with the letter, or by calling their agency. Members who have provided an email address will also receive an email when their benefits are renewed asking them to answer the question.
  • Members whose benefits cannot be renewed based on information on file and obtained from data exchanges will be asked the question right when they renew if they renew using the ACCESS website or by calling their agency. If they choose not to answer at that time or renew their benefits by paper, they’ll receive a letter asking them to answer the question. They can then answer through the ACCESS website, the MyACCESS mobile app, a paper form, or phone with their agency. Members who have provided an email address will also receive an email at the time of their renewal informing them of the requirement to answer the question.

One-Time Letters

BadgerCare Plus childless adult members received a letter in November first notifying them of the emergency room copay, monthly premiums, and treatment needs question. Childless adult members will receive another letter notifying them of the monthly premiums and treatment needs question at the same time they receive their yearly renewal letter.

Other Policy Changes

In addition to the emergency room copay, monthly premiums, and treatment needs question requirements, the waiver amendment included an employment and training requirement for childless adults as well as increased coverage of residential substance use disorder treatment for all full-benefit BadgerCare Plus and Medicaid members. The implementation date of these two changes is still being determined.

Additional Information

Additional information about the upcoming BadgerCare Plus program changes, including FAQs and a toolkit, are available on the Wisconsin Department of Health Services website.

Questions

If you have questions about the upcoming BadgerCare Plus program changes, please email dhswisconsin1115clawaiver@dhs.wisconsin.gov. While emails will not be responded to individually, the Wisconsin Department of Health Services will be monitoring the questions and updating communications, including the FAQs, as applicable.

Members who have questions about the upcoming changes can be directed to call ForwardHealth Member Services at 800-362-3002, Monday through Friday, from 8 a.m. to 6 p.m.