Governor Walker's Entitlement Reform Plan
Through Governor Walkerís Entitlement Reform Plan, all Wisconsinites
have access to affordable health care coverage. People living in poverty have coverage through Medicaid while individuals and
families above the poverty level have access to affordable private
health care coverage through the federal
Health Insurance 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 mirrored the federal
governmentís implementation of the 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.
- As of June 30, 2014, provides 97,509 childless adults living in poverty who
previously did not have access to health care coverage coverage with Medicaid's
- 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
- Provides health care coverage to all BadgerCare Plus members
BadgerCare Plus Standard Plan.
Department of Health Services and Office of the Commissioner of
Insurance Joint Report: The Wisconsin Health Insurance Market and
Wisconsin Entitlement Reforms
On March 31, 2014, the Department of Health Services (DHS) and the
Office of the Commissioner of Insurance (OCI) released a joint report on
Wisconsin's unique approach for operationalizing the Affordable Care Act
and Wisconsin entitlement reforms.
Governor Walker Calls for Three Month Delay of Entitlement
On November 14, 2013, 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 did not take effect until April 1, 2014. The health care
changes that were included in the budget were delayed, including changes
to BadgerCare Plus eligibility and BadgerCare Plus plan design.
The following health care policy changes that were included in the
Governorís entitlement reform plan were postponed until April 1,
- Eligibility for childless adults with incomes below 100% of the
federal poverty level enrolling for and receiving BadgerCare Plus
- All BadgerCare Plus members receiving the same health care
benefits through the Standard Plan.
- Elimination of the BadgerCare Plus Benchmark, Core and Basic
- 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 worked 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
more than 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
The Department and CMS announced federal approval of Wisconsin's
BadgerCare Reform waiver on January 9, 2014. The new waiver became
effective January 1, 2014 and goes through December 31, 2018.
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 &
Wisconsin Health Care Options
Governor Walker's 2013-2015 Biennial Budget
Last Revised: September 29, 2014