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Wisconsin Department of Health Services

 

 

Governor Walker's Entitlement Reform Plan

Through Governor Walkerís Entitlement Reform Plan, all Wisconsinites will have access to affordable health care by ensuring that people in poverty have coverage through Medicaid while connecting individuals and families above the poverty level to private coverage through the federal health insurance exchange, called the Marketplace. Approved as part of the 2013-15 state budget, this plan is projected to reduce the number of uninsured in our state by 224,580, or roughly half, while strengthening the stateís safety net for Wisconsin's neediest residents.

The Wisconsin Medicaid programs, including BadgerCare Plus, were created to be an essential safety net for low-income individuals and families who lose or cannot afford employer-sponsored health insurance. The broad eligibility criteria and comprehensive benefits offered by the programs have helped Wisconsin maintain one of the highest rates of health insurance coverage in the country.

The Governorís reforms balance the need to maintain a strong and sustainable health care safety net with ensuring the greatest number of people possible can afford to remain in the private health insurance market and maintain their independence.

Overview of Governor Walker's Entitlement Reform Plan

Governor Walker's Entitlement Reform Plan was approved and signed into law on June 30, 2013 as part of 2013-2015 biennial budget. Implementation of the Governorís Medicaid reforms will mirror the federal governmentís implementation of the Marketplace. This coordination will ensure a smooth transition for individuals who are either entering Medicaid or who are newly eligible for health insurance assistance in the federal Marketplace.

The Governorís Entitlement Reform Plan in summary:

  • Reduces the number of uninsured adults by an estimated 224,580, cutting the uninsured rate nearly in half.
  • Maintains current coverage levels for seniors, people with disabilities, and pregnant women, as well as children whose family income is up to 300% of the federal poverty level.
  • Provides more than 82,000 childless adults living in poverty who previously did not have coverage with access to Medicaid's safety-net coverage.
  • Covers all eligible adults living in poverty, with those above 100% of the federal poverty level able to access private coverage through the federal health insurance exchange, called the Marketplace.
  • Provides health care coverage to all BadgerCare Plus members through the BadgerCare Plus Standard Plan.

Governor Walker Calls for Three Month Delay of Entitlement Reform

On November 14, 2014, Governor Walker called for a special session of the Legislature to take up Legislation that would allow individuals currently enrolled in BadgerCare Plus more time to enroll in a health care plan through to the federal health insurance Marketplace. As a result, the health care changes that were slated to be implemented on January 1, 2014 are not scheduled to take effect until April 1, 2014. The health care changes that were included in the budget have been delayed, including changes to BadgerCare Plus eligibility and BadgerCare Plus plan design. BadgerCare Plus policies currently in effect remain until March 31, 2014 and BadgerCare Plus will continue operating the way it is today through March 31, 2014.

The following health care policy changes that were included in the Governorís entitlement reform plan will be postponed until April 1, 2014:

  • Eligibility for childless adults with incomes below 100% of the federal poverty level enrolling for and receiving BadgerCare Plus benefits.
  • All BadgerCare Plus members receiving the same health care benefits through the Standard Plan.
  • Elimination of the BadgerCare Plus Benchmark, Core and Basic Plans.
  • Premiums for individuals in a BadgerCare Plus extension (also known as Transitional Medicaid) with incomes between 100 and 133% of the federal poverty level.

Governor Walker's press release announcing the three month delay

BadgerCare Plus Demonstration Project Waiver Request

The Department of Health Services is working closely with the Centers for Medicare and Medicaid Services (CMS) on a waiver to provide all childless adults under 100% FPL with Medicaid for the first time in the stateís history. This bolstering of the stateís safety net will provide nearly 100,000 Wisconsin residents who live in poverty with health care under the stateís Standard Medicaid benefit. Additional information about the Departmentís waiver for childless adults.

Finally, the Department is committed to working with stakeholders, advocates and members in implementing these reforms. Despite short timelines, the Department is confident that by working together, we can provide affordable health care coverage to the residents of Wisconsin.

Regional Enrollment Networks

One of Wisconsinís most significant strategies to assist Wisconsin residents with enrolling in the appropriate public or private health care coverage will be through the recently announced Regional Enrollment Networks (RENs). The RENs will be comprised of various community partners, health care providers, income maintenance consortia, managed care entities, and other key stakeholders. These RENs will be developed at the local level and may be different from each other depending on the needs of the local region.

On July 16, 2013, the Department of Health Services and the Office of the Commissioner of Insurance presented a proposed model assisting Wisconsin residents with enrolling in the appropriate public or private health care coverage through Regional Enrollment Networks (RENs) at the UW-Population Health Instituteís Wisconsin Health Insurance Outreach & Enrollment Summit. 

Wisconsin Health Care Options in 2014

Governor Walker's 2013-2015 Biennial Budget Request

Last Revised: June 11, 2014