Medicaid: BadgerCare Waiver

The BadgerCare waiver provides robust state plan benefits to childless adults who are not pregnant, disabled, or elderly with incomes of up to and including 100% of the federal poverty level and to transitional medical assistance individuals, also known as members on extension, with incomes over 100% of the federal poverty level.

  • The waiver includes a substance use disorder program that expands the substance use disorder benefits package to cover short-term residential services in facilities that qualify as institutions for mental diseases for all Medicaid enrollees.
  • The waiver also allows Wisconsin to implement additional eligibility and cost-sharing components that apply only to the nonmandatory childless adult population.

DHS must get approval from CMS to extend the BadgerCare waiver beyond December 31, 2023. 

About Section 1115 Demonstration Waivers

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and Children’s Health Insurance Programs. Under this authority, the Secretary may waive certain provisions of the Medicaid law to give states extra flexibility to design and improve their programs. Learn more about Section 1115 Demonstration Waivers (opens external link).

BadgerCare Waiver Extension: January 1, 2024 – December 31, 2028

The Department of Health Services (DHS) will submit an application to the Centers for Medicare and Medicaid Services (CMS) in mid-November 2022. It will request a five-year extension of the current Medicaid 1115 Research and Demonstration Waiver. DHS is not seeking changes. The next demonstration period runs from January 1, 2024, to December 31, 2028.

The current waiver provides coverage to the childless adult and transitional medical assistance populations. It also gives Wisconsin authority to implement additional eligibility and cost-sharing components for childless adults, including premiums, copayments for non-emergency use of the emergency department, and a health risk assessment as a condition of eligibility. The waiver also provides coverage of short-term residential services in facilities that qualify as institutions for mental diseases for all Medicaid enrollees.

As of July 1, 2022, more than 277,000 individuals receive coverage under this demonstration authority.


BadgerCare Waiver Amendment for Health Savings Accounts

In 2020, Wisconsin submitted an amendment request to CMS to add health savings accounts for the childless adult population under the BadgerCare waiver. CMS approval is pending. 


BadgerCare Waiver Amendment and Extension: October 31, 2018 – December 31, 2023

Last revised January 18, 2024