Demonstration Project Waiver
The Wisconsin Department of Health Services is requesting a new five-year Section 1115 BadgerCare Plus Demonstration Project Waiver. The current BadgerCare Plus Core Plan for Adults Without Dependent Children Demonstration Project Waiver expires on December 31, 2013. The Department held three public information sessions in July 2013 to provide information about the waiver and to collect comments from the public regarding the waiver request. All public comments were due by August 5, 2013. The Department submitted the waiver to the federal Department of Health and Human Services (DHHS) on August 9, 2013.
If Wisconsin’s BadgerCare Plus Demonstration Project Waiver is approved by DHHS; effective January 1, 2014, Wisconsin will provide coverage to adults without dependent children who have attained the age of 19 and have not yet attained the age of 65 years with Medicaid coverage so long as their family income does not exceed 100% of the Federal Poverty Level (FPL). Additionally, Wisconsin will begin requiring a monthly premium for parents and caretakers relatives who qualify for transitional medical assistance (TMA).
The Department held three (3) public hearings and one (1) tribal consultation around the State to solicit input on the BadgerCare Plus Demonstration Project Waiver request. Written or verbal statements were able to be made at the following public hearings:
In addition, written comments were able to be sent by fax, e-mail, regular mail to the Department or be submitted online. Comments were due no later than August 5, 2013.
Public comments will be included in the waiver request submitted to CMS on August 9, 2013.
The Department submitted the BadgerCare Plus Demonstration Project Waiver to CMS on August 9, 2013.
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History of the Program
Wisconsin currently covers adults without dependent children (referred to as ‘childless adults’ throughout this notice) with incomes not exceeding 200% FPL, at the time of application or renewal, under the BadgerCare Plus Core Plan. Because of the federal budget neutrality requirements of the Core Plan waiver, enrollment has been capped since October 2009. As of April 2013 there were more than 145,000 individuals on a wait list. The limited benefit plan provided to this population does not meet either the federal creditable coverage requirement or the new Patient Protection and Affordable Care Act (PPACA)-mandated Essential Health Benefits requirements. The current BadgerCare Plus Core Plan for Adults Without Dependent Children demonstration project waiver expires on December 31, 2013.
The Department intends to submit a new demonstration project waiver to cover those childless adults, ages 19-64 years old, who meet Medicaid non-financial requirements (SSN, citizenship/identity, etc.); are not otherwise eligible for full-benefit Medicaid; are not entitled to Medicare; and have a gross income, calculated using the federally-mandated Modified Adjusted Gross Income (MAGI) methodology including a 5% disregard, not exceeding 100% of the FPL. Eligible individuals will no longer be required to pay an annual enrollment fee or a premium, and the program will not be subject to an enrollment cap. Eligible individuals will be enrolled in the BadgerCare Plus Standard Plan, which is the same plan provided to all beneficiaries enrolled in BadgerCare Plus.
The Department is also incorporating changes to the current Transitional Medicaid Assistance (TMA) Premium and Restrictive Re-Enrollment Period component of the Medicaid 2014 Demonstration Project Waiver into the new BadgerCare Plus Demonstration Project Waiver. TMA currently allows individuals to maintain their Medicaid coverage for 12 additional months if:
As part of the Medicaid 2014 Demonstration Project Waiver request (effective July 1, 2012), amending the BadgerCare and BadgerCare Plus for Childless Adults waivers, Wisconsin received waiver approval that allows us to require that non-pregnant, non-disabled adult individuals receiving Medicaid, including those on TMA with family incomes that exceed 133% of the FPL pay a monthly premium to maintain their Medicaid coverage. Those who either refuse to pay their monthly premium or who fail to pay a premium may be subject to a restrictive re-enrollment period, as currently applies.
If approved in the new BadgerCare Plus Demonstration Project Waiver, effective January 1, 2014, all adult parents and caretaker relatives who qualify for BadgerCare Plus coverage through TMA only, not just those with income not exceeding 133% FPL, will be required to pay the TMA premium. All other provisions of the current TMA policy remain the same. Individuals will continue to be covered under the BadgerCare Plus Standard Plan benefit plan with the same copayments and other cost sharing requirements as all other BadgerCare Plus beneficiaries, outside of the monthly premium.
Population and Numbers Served
If approved, the new BadgerCare Plus Demonstration Project Waiver would cover those individuals who:
The Department estimates that nearly 99,000 childless adults will enroll in BadgerCare Plus between January 1, 2014 and December 31, 2014.
The Department estimates that by January 1, 2014, when the change in TMA policies under this waiver is implemented, there will be 15,000 adult parents and caretaker relatives eligible under the TMA program. The new premium income limit of 100% of the FPL may result in 23% (3,450) reduction in the number of eligible adults.
Last Revised: August 15, 2013