Highlight on Wisconsin: CMS Approves BadgerCare Reform Waiver

CMS has approved Wisconsin’s BadgerCare Reform Waiver, expanding the state’s access to health care beginning April 1, 2014. According to the Wisconsin Department of Health Services (Department), the waiver will: (1) offer standard plan benefits to all BadgerCare Plus members; (2) abolish the BadgerCare Plus Core Plan; (3) eliminate the existing enrollment cap for childless adults under 100 percent of the federal poverty level; and (4) require transitional medical assistance qualified parents and caretakers to pay monthly premiums.

“For the first time in our state’s history, everyone living in poverty will have access to health care through Medicaid in 2014,” stated Governor Scott Walker in a Department news release. “Wisconsin has a long history of providing quality care to its residents. Our reforms maintain Medicaid as a safety net for our state’s most vulnerable and ensure there is no gap in health care coverage in Wisconsin,” he said.

The waiver makes BadgerCare Plus coverage available to people who: (1) are between 19 and 64 years old; (2) are not eligible for BadgerCare Plus for Families or Medicaid; (3) are not qualified for Medicare; (4) meet all non-financial requirements of Medicaid, such as citizenship, Social Security number, etc.; and (5) have a gross income that does not exceed 100 percent of the federal poverty level.

Department Secretary Kitty Rhoades noted, “The approval of the BadgerCare Reform waiver is the last step needed to allow us to implement Governor Walker’s Entitlement Reform Plan and provide all Wisconsin citizens with access to affordable health care.” The Governor’s Entitlement Reform Plan was signed into law on June 30, 2013, and was part of his 2013-2015 biennial budget. Secretary Rhoades continued, “The Governor’s reforms will strengthen health care in Wisconsin and provide Wisconsin residents with opportunities in the commercial health care market and will reduce Wisconsin’s uninsured rate in half.”

CMS noted that its approval of the waiver is conditioned on the state’s compliance with special terms and conditions, including compliance with: federal non-discrimination statutes; Medicaid law, regulation, and policy; changes in Medicaid law, regulation, and policy; general reporting requirements; general financial requirements; and public notice, tribal constitution, and consultation with interested parties requirements. Wisconsin was also required by CMS to submit written acknowledgement of the award and acceptance of the CMS special terms and conditions.

Secretary Rhoades submitted the state’s written acknowledgement and acceptance to CMS on January 9, 2014, noting, “The agreement we have reached is historic,” and “we are improving the lives of thousands of Wisconsin residents.”