In the latest Medicaid waiver, Wisconsin Governor Scott Walker secured a number of cost-sharing provisions and a transfer of thousands of beneficiaries to Healthcare.gov, setting the stage for other Republican governors to find an acceptable option.
Under the waiver, originally proposed in July with some provisions that the Centers for Medicare & Medicaid Services rejected, Wisconsin's BadgerCare program is expanding eligibility for childless adults earning up to 100 percent of the federal poverty level, and at the same time ending covering for current beneficiaries earning up to 200 percent of FPL, who will now be offered premium tax credits to buy private health plans in the health insurance exchange.
The state estimates that about 77,000 adults who earn between 100 percent and 200 percent of the poverty line will move to exchange coverage, while as many 83,000 low-income childless adults will now qualify for Medicaid.
"The agreement we have reached is historic," Wisconsin Department of Health Services secretary Kitty Rhodes wrote in a letter to CMS administrator Marilyn Tavenner. The "entitlement reforms make certain that all residents of our state have access to affordable health insurance options for the first time," she wrote.
The Medicaid section 1115 waiver takes effect in April and continues through December 31, 2018. As part of it, Wisconsin is extending essential health benefits to all of its Medicaid programs, with behavioral health, substance abuse treatment and prevention benefits offered for the first time to low-income childless adults in BadgerCare.
Wisconsin's Medicaid program is also requiring parents and caretaker relatives in the transitional medical assistance program to make financial contributions, although CMS did not approve all of the Walker administration's ideas.
CMS allowed Wisconsin to charge transitional medical assistance premiums to those earning above 133 percent of the federal poverty level in 2012. Now the state can charge premiums to those earning above 100 percent FPL, on a sliding-scale fee in line with insurance exchange monthly rates and limited to 2 percent of income.
The state had proposed terminating adult coverage for 12 months for beneficiaries who fail to pay premiums, but CMS set less punitive disqualification terms. The state can now disenroll adults only after three months of nonpayment and must offer a 30 day grace period and the ability to re-enroll after paying owed premiums.