August 8, 2013
Claire Yunker, 608-266-1683

Department of Health Services Submits BadgerCare Plus Waiver to Centers for Medicare and Medicaid Services

Waiver will allow Department to provide access to health care for all adults living in poverty

MADISON-The Department of Health Services today announced that it has submitted a new BadgerCare Plus Demonstration Project Waiver to the Centers for Medicare and Medicaid Services (CMS). The waiver is part of Governor Walker's entitlement reform initiative and will allow 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.

"Today's submission of the new BadgerCare Plus waiver takes us one step closer to realizing Governor Walker's goal of providing all Wisconsin citizens with access to affordable health care," said Wisconsin Medicaid Director Brett Davis. "We expect a significant reduction in the number of uninsured adults in Wisconsin as a result of the Governor's efforts."

Governor Walker's entitlement reform plan was approved and signed into law on June 30, 2013 as part of 2013-2015 biennial budget. The Department of Health Services is working with the federal government to get the federal approval needed to make these changes through the waiver request.

As part of the waiver submission process, the Department provided the opportunity for public comment on the proposed waiver through in person town hall meetings and an online submission form. Many of the comments that the Department received related to definitions and clarifications of certain terms used in the waiver application, questions on the benefits that members will receive, and questions on differences between the new waiver and the existing waivers. The waiver request includes all of the comments that the Department received.

In addition, the type of waiver that the Department is submitting allows states the flexibility to customize their Medicaid and Children's Health Insurance Program (CHIP) - called BadgerCare Plus in Wisconsin-programs to meet the needs of their citizens, as long as it is at no additional cost to taxpayers. Through this waiver, Wisconsin seeks to provide full Medicaid benefits through the Standard Plan, including enhanced mental health benefits and preventive benefits, to all adults in poverty who are enrolled in Medicaid and BadgerCare Plus. It is anticipated that offering the same benefits to all adults in poverty will lead to savings for Wisconsin taxpayers because helping individuals get access to these enhanced benefits in the primary care setting will help avoid costly and unnecessary emergency room and in-patient hospital stays.

Wisconsin's current BadgerCare Plus Childless Adults Demonstration Project waiver expires on December 31, 2013. Pending approval by the federal government, the new BadgerCare Plus Demonstration Project Waiver will become effective January 1, 2014 and will provide coverage to individuals who:

  • Are between ages 19 and 64 years old,
  • Are not pregnant or parents or caretaker relatives of children under age 19,
  • 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.

For additional information about the waiver, go to