DHS Submits BadgerCare Changes to CMS

On June 7, 2017, the Wisconsin Department of Health Services (DHS) submitted their final application to the Centers for Medicare and Medicaid Services (CMS) to amend the BadgerCare program for childless adults. The amendment makes several changes to the program including monthly premiums, copays for emergency room usage, a health risk assessment, work requirements tied to a 48-month eligibility limit, and drug screening and testing*. Many of these changes were required by Wisconsin Act 55 (2015-2017 biennial budget).

DHS received over 1,000 public comments after the draft waiver documents were released on April 19, 2017, and made the following updates based on this feedback:

  • Monthly Premiums: Rather than imposing three different premium amounts varying by household income, there will now be only one premium amount ($8/month), for households with incomes between 51-100% of the federal poverty level.
  • Emergency Room Copays: Rather than charging $8 for the first ER visit, and $25 for a second visit within a 12-month period, there will now be an $8 copay charged at each ER visit, regardless of frequency.
  • Drug Screening and Testing: Rather than a six-month ineligibility period for refusal to consent to treatment after a positive test, the final waiver clarifies that an individual can reapply at any time if they consent to treatment. Also, the final waiver adds an option for individuals who state during their screening that they are ready to pursue treatment to skip the drug test and enter treatment (and still be eligible for BadgerCare). *Update Posted 12/10/18: CMS approved DHS' waiver request on 10/31/2018. The final approved waiver does not include drug screening and testing. Instead, all applicants will be required to submit the Health Risk Assessment, which was originally optional

Although DHS acknowledged that they received several comments specifically requesting that individuals with cancer (and other chronic diseases, terminal illnesses, etc.) be exempted from both monthly premiums and emergency room copays, and also that they clarify that individuals with cancer would meet the “physically or mentally unable to work” exemption from the work requirement, they did not specifically address these comments in the final waiver documents. They did state that they would consider operational suggestions as they work out the details of the waiver with CMS and during implementation planning, and that they would work with stakeholders to do that.

Additional details about the final waiver are included on the DHS website, and in the updated FAQ here. Also, check out this brief by the Kaiser Family Foundation for a high-level analysis of the waiver.

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