Through Governor Walker's 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 state's 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 Governor's 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 the 2013-2015 biennial budget. Implementation of the Governor's Medicaid reforms mirrored the federal government implementation of the Marketplace.
The Governor's 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 safety-net coverage.
- 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 Marketplace.
- Provides health care coverage to all BadgerCare Plus members through the 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.
- View the full report. (PDF, 32 MB)
- View the report narrative. (PDF, 419 KB)
- View a letter from DHS Secretary Kitty Rhoades and OCI Commissioner Ted Nickel regarding the joint report. (PDF, 47 KB)
Governor Walker Calls for Three Month Delay Entitlement Reform
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 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 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 Governor's entitlement reform plan were postponed until April 1, 2014:
- Eligibility for childless adults with incomes below 100% of the federal poverty level.
- All BadgerCare Plus members receiving the same health care benefits through the Standard Plan.
- Elimination of the BadgerCare Plus Benchmark, Core and Basic Plans.
- Premiums for individuals in a BadgerCare Plus extension (also known as Transitional Medicaid) with incomes between 100 and 133% of the federal poverty level.
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 state's history. This bolstering of the state's safety net will provide more than 100,000 Wisconsin residents who live in poverty with health care under the state's Standard Medicaid benefit. For additional information about the Department's waiver for childless adults contact DHS.
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 Wisconsin's most significant strategies to assist Wisconsin residents enrolling in the appropriate public or private health care coverage is through the Regional Enrollment Networks (RENs). The RENs are comprised of various community partners, health care providers, income maintenance consortia, managed care entities, and other key stakeholders. These RENs are 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 Institute's Wisconsin Health Insurance Outreach & Enrollment Summit.