Changes to BadgerCare Plus for childless adults start February 1, 2020
There are changes to BadgerCare Plus that will affect adults ages 19–64 who are not pregnant and do not have dependent children living in the home. These new rules begin February 1, 2020.
- Monthly premiums (depending on income).
- An optional health survey to help lower monthly premiums.
- A treatment needs question.
- A copay for visits to the emergency room that are not an emergency. However, members are exempt from paying copays until July 1, 2020, in order for Wisconsin Medicaid to comply with federal cost share requirements.
These changes are a result of an amendment to a Section 1115 demonstration waiver.
Stakeholder input welcome
Feedback from stakeholders is essential to helping DHS understand how BadgerCare Plus changes impact our members and to helping DHS learn more about how we can improve our member’s experience in the future. Email the BadgerCare Changes for Childless Adults mailbox.
New policies went into effect on February 1, 2020.
Join the ForwardHealth Community Partner email list to stay informed about updates on the BadgerCare Plus changes.
BadgerCare Plus changes demonstration waiver background
Wisconsin’s authority to cover childless adults under BadgerCare Plus comes from a Section 1115 demonstration waiver.
To learn more about information on the history, timeline, and submission of the waiver, see Section 1115 BadgerCare Reform Demonstration Waiver.
Description of BadgerCare Plus changes for childless adults
Emergency room copay
BadgerCare Plus childless adult members who use the emergency room for non-emergency reasons will be charged an $8 copay.
- There is no copay for visits to the emergency room that are emergencies.
- The physician decides if the visit was an emergency.
- Emergency rooms are required to see patients in the case of an emergency per federal law.
Members are exempt from paying copays until July 1, 2020, in order for Wisconsin Medicaid to comply with federal cost share requirements.
BadgerCare Plus childless adult members with household incomes over 50 percent of the FPL will be charged up to $8 each month for their entire household.
Optional health survey
Members will be given the option to complete a health survey. If members are affected by premiums, they can reduce their monthly premium by reporting healthy behaviors such as wearing a seatbelt, exercising, and not smoking. Premiums may be reduced by up to half based on completion of a health survey.
Treatment needs question
To be eligible, members must answer a question about their drug use during the last 12 months and, if applicable, their willingness to enter treatment.
When members apply for or renew benefits, they will be asked:
- If they have used drugs in ways that have caused problems for themselves or those around them in the past 12 months.
- If they are open to getting help.
Their answer will not affect their health care benefits in any way.
Frequently asked questions
These FAQs provide information about the upcoming changes intended for members, providers, partners, stakeholders, and the public.
BadgerCare Reform Partner Tool Kit
This tool kit provides partners with resources to help inform members about the upcoming changes to BadgerCare Plus.