January 9, 2014
Claire Yunker, 608-266-1683

Department of Health Services Receives Approval for New BadgerCare Plus Waiver

Waiver allows Department to provide access to health care for all adults living in poverty beginning April 1, 2014

MADISON-The Department of Health Services today announced that the federal Centers for Medicare and Medicaid Services (CMS) has approved Wisconsin's BadgerCare Reform waiver. The new waiver became effective January 1, 2014 and goes through December 31, 2018.

"For the first time in our state's history, everyone living in poverty will have access to health care through Medicaid in 2014," said Governor Scott Walker. "Wisconsin has a long history of providing quality care to its residents. Our reforms maintain Medicaid as a safety net for our state's most vulnerable and ensure there is no gap in health care coverage in Wisconsin."

"The approval of the BadgerCare Reform waiver is the last step needed to allow us to implement Governor Walker's Entitlement Reform Plan and provide all Wisconsin citizens with access to affordable health care," said Secretary Kitty Rhoades. "The Governor's reforms will strengthen health care in Wisconsin and provide Wisconsin residents with opportunities in the commercial health care market and will reduce Wisconsin's uninsured rate in half."

Governor Walker's entitlement reform plan was approved and signed into law on June 30, 2013 as part of 2013-2015 biennial budget. 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 beginning April 1, 2014. The 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.

For additional information about the waiver, please contact DHS.