The Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects by allowing the Secretary to waive provisions of the Medicaid law. These projects are often referred to as “1115 demonstration projects,” and must promote the objectives of the Medicaid programs. The purpose of the governor’s proposal is to improve health, reduce costs, and move more people into the workforce.
The governor’s proposal is targeted at a group of people who are referred to as “childless adults.” Specifically, the governor is proposing the following changes to Wisconsin’s Medicaid program, known as BadgerCare:
- Drug screening participants, with those testing positive being offered treatment before losing Medicaid benefits.
- Time limiting benefits to 48 months, but the time limit does not apply if the participant is working or participating in a worker training program.
- Establishing a monthly premium between $0 to $10 per household, based on income.
- Increasing copayments for emergency room visits to $8 for the first visit and $25 for subsequent visits, in order to encourage care in the most appropriate place.
- Utilizes a health risk assessment that rewards healthy behavior by lowering premiums. Healthy choices include wearing a seatbelt, maintaining a healthy weight, not smoking, and not abusing drugs or alcohol.
The governor has stated that "[t]hese are common sense reforms directed at helping people move from government dependence to true independence through the dignity that is born of work." He added, “[w]e are asking able-bodied adults without children, who are on government assistance, to pass a drug test and enroll in job training. If they fail the test, we'll help them get healthy so they can get the job skills they need to get back in the game." Critics, on the other hand, have asserted that these changes will lead to more drug dependence without access to Medicaid, and that $10 premiums will cost more to manage than they will save.
The Wisconsin Department of Health Services will accept written comments on the proposal and hold public hearings on April 26 and May 1. The governor intends to submit his formal request on May 26, 2017.