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Demonstration Project Waiver

Overview

The Wisconsin Department of Health Services received approval for a new five-year Section 1115  Demonstration Project Waiver, the BadgerCare Reform Waiver. The new waiver became effective January 1, 2014 and goes through December 31, 2018.

The waiver allows Wisconsin to provide health care coverage through BadgerCare Plus to all childless adults between ages 19 and 64 and who have incomes that do not exceed 100% of the federal poverty level (FPL) beginning April 1, 2014. The 2013-15 biennial budget had originally planned for the program changes to go into effect on January 1, 2014; however, due to challenges with the federal Health Insurance Marketplace, Governor Walker and the Wisconsin Legislature delayed these changes by 90 days to April 1, 2014. 

Through the BadgerCare Reform waiver, Wisconsin will provide full Medicaid benefits through the Standard Plan, including enhanced mental health benefits, substance abuse treatment and prevention benefits, to all adults in poverty who are enrolled in Medicaid and BadgerCare Plus. Previously, this level of coverage had not been available to childless adults.

Beginning April 1, 2014, the new BadgerCare Reform waiver will allow Wisconsin to provide BadgerCare Plus health care coverage to individuals who:

  • Are between ages 19 and 64 years old,
  • Are not otherwise eligible for BadgerCare Plus for Families or Medicaid,
  • Are not entitled to Medicare,
  • Meet all Medicaid non-financial requirements like citizenship and identity, SSN, etc., and
  • Have a gross income, calculated using the federally-mandated Modified Adjusted Gross Income (MAGI) methodology, that does not exceed 100% of the FPL before application of a 5% disregard.

The waiver will implement the following changes to BadgerCare Plus:

  • Provide all BadgerCare Plus members with Standard Plan benefits,

  • Eliminate the BadgerCare Plus Core Plan,

  • Remove the current enrollment cap for childless adults under 100% FPL, and

  • Require all parents and caretaker relatives who qualify for transitional medical assistance (TMA) to pay a monthly premium. TMA adults with incomes above 133% FPL will be required to pay a monthly premium once they qualify for TMA and adults with incomes from 100% FPL to 133% FPL will begin paying monthly premiums after the first six months of TMA coverage.

Waiver Documents

January 2014: View the Department's Letter Accepting CMS' BadgerCare Reform Waiver Agreement (PDF, 160 KB)

December 2013: View the Center for Medicare and Medicaid Services' (CMS) BadgerCare Reform Waiver Approval Letter (PDF, 44 KB)

December 2013: View the BadgerCare Reform Waiver Special Terms and Conditions (PDF, 607 KB)

December 2013: View the BadgerCare Reform Waiver Expenditure Authority (PDF, 115 KB)

December 2013: View the BadgerCare Reform Waiver Authority List (PDF, 8 KB)

August 2013: Updated August 15, 2013: View Wisconsin's BadgerCare Plus Demonstration Project Waiver submitted to the federal government (PDF, 2.7 MB)

July 2013: View the public notice about the BadgerCare Plus Demonstration Project Waiver. (PDF, 339 KB)

July 2013: View Wisconsin's Proposed BadgerCare Plus Demonstration Project Waiver Request - Version Reviewed for Public Comment - July 2013. (PDF, 417 KB)

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Accessibility

English
DHS is an equal opportunity employer and service provider. If you need accommodations because of a disability or need an interpreter or translator, or if you need this material in another language or in an alternate format, you may request assistance to participate by contacting Al Matano at (608)267-6848. You must make your request at least 7 days before the activity.

Spanish
DHS es una agencia que ofrece igualdad en las oportunidades de empleo y servicios. Si necesita algún tipo de acomodaciones debido a incapacidad o si necesita un interprete, traductor o esta información en su propio idioma o en un formato alterno, usted puede pedir asistencia para participar en los programas comunicándose con Kim Reniero al número (608)267-7939. Debe someter su petición por lo menos 7 días de antes de la actividad.

Hmong
DHS yog ib tus tswv hauj lwm thiab yog ib qhov chaw pab cuam uas muab vaj huam sib luag rau sawv daws. Yog koj xav tau kev pab vim muaj mob xiam oob qhab los yog xav tau ib tus neeg pab txhais lus los yog txhais ntaub ntawv, los yog koj xav tau cov ntaub ntawv no ua lwm hom lus los yog lwm hom ntawv, koj yuav tau thov kev pab uas yog hu rau Al Matano ntawm (608)267-6848. Koj yuav tsum thov qhov kev pab yam tsawg kawg 7 hnub ua ntej qhov hauj lwm ntawd.

 

Last Revised:  January 09, 2014