Background

In October 2018, the Centers for Medicare & Medicaid Services approved the Wisconsin Department of Health Services (DHS) Section 1115 BadgerCare Reform demonstration waiver amendment. The amendment allows Wisconsin to continue to provide Medicaid coverage for adults ages 19–64 who do not have dependent children under the age of 19 living in their home. These adults are referred to as childless adults.

The amendment also contains several policy changes for childless adults, some of which are being implemented starting February 1, 2020. These policy changes include the following:

• Members will have to pay an $8 emergency room copayment for going to the emergency room when it is not an emergency.
• Depending on their income, members will have to pay a monthly premium of up to $8. Members can lower their monthly premiums by taking an optional health survey and showing they have healthy habits, have a health condition that keeps them from participating in healthy habits, or are managing their health risks.
• Members will have to answer a treatment needs question when they apply for or renew their BadgerCare Plus benefits.

In addition to the changes above, the amendment includes an employment and training requirement for childless adults as well as increased coverage of residential substance use disorder treatment for all full-benefit BadgerCare Plus and Medicaid members. The implementation date of the employment and training requirement is still being determined. While DHS is still finalizing the implementation date of the increased coverage of residential facility substance use disorder treatment, it is expected to be February 1, 2020.

Available Communications

Educating members about the upcoming policy changes will be an ongoing and joint effort between DHS and its partners. To aid in this effort, DHS is making a toolkit available that includes:

• A ForwardHealth Member Update. This is a one-time letter that was mailed to approximately 150,000 childless adults on November 1, 2019, announcing the changes effective February 1, 2020.
• A handout. This handout provides a high-level overview of the changes effective February 1, 2020. Providers are encouraged to print and distribute the handout to members who may be affected by the changes.
• Social media. These are cut-and-paste graphics and messages that providers can share on their own social media platforms.
• FAQs. The FAQs provide information about these changes for members, providers, partners, stakeholders, and the public.
• Presentation. Information about the changes is available in a PowerPoint presentation and a recorded webcast.

The toolkit, as well as more information about the changes, is available on the DHS website.

Questions

Providers who have questions about the upcoming changes that are not addressed by the current communications can email dhswisconsin1115clawaiver@dhs.wisconsin.gov. While emails will not be responded to individually, DHS will be monitoring the questions and updating communications, including the FAQs, as needed.

Members who have questions about the upcoming changes can be directed to call ForwardHealth Member Services at 800-362-3002, Monday through Friday, from 8 a.m. to 6 p.m.

For most members who are currently eligible for BadgerCare Plus as childless adults, the premiums and treatment needs question will take effect as of their next renewal due on or after March 31, 2020. Members who will be impacted by these changes will receive a more detailed letter the month before their next renewal.