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
- 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.
Governor Walker Calls for Three Month Delay of Entitlement
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,
- 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 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
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. View the Department's
Regional Enrollment Network presentation. (PDF,
Wisconsin Health Care Options in 2014
Governor Walker's 2013-2015 Biennial Budget
Last Revised: November 19, 2013