CMS just approved #Wisconsin’s request to extend and amend its Section 1115 #Medicaid demonstration waiver. Wisc. is unique in that it covers childless adults up to the federal poverty level (at the state’s regular matching rate). medicaid.gov/Medicaid-CHIP-…
CMS approved 3 new conditions of Medicaid eligibility for childless adults in #WI today: (1) a work & reporting requirement for those ages 19-49; (2) $8 monthly premiums for those from 50-100% FPL; & (3) fully completing a health risk assessment at application & annual renewal.
The penalty for failing to meet the new work & reporting requirements for any 48 months is coverage loss, with a 6-month lockout period.
The 48-month time period for Wisc. Medicaid #WorkRequirements won’t start for at least a year. More detail about the work requirement, including how the state will require individuals to report compliance, will be in an implementation plan due to CMS within 90 days.
Consistent with CMS policy, no #Medicaid funds will be spent on work supports like transportation or job training. Instead, the state will “[m]ake good faith efforts to connect beneficiaries to existing community supports.”
The penalty for failing to pay premiums under Wisconsin’s new waiver is coverage loss with a lockout period up to 6 months, after a “reasonable opportunity” to pay any unpaid amounts. Premium payments will be reviewed annually when eligibility is renewed.
People who complete the health risk assessment & self-attest to actively managing certain behaviors can have premiums reduced by 50%. Targeted behaviors include excessive alcohol consumption, maintaining healthy weight, illicit drug use, failure to use a seat belt, & tobacco use.
CMS recognizes that the new waiver “could result in some beneficiaries losing coverage.” But, CMS says that if it didn't approve #WI's request, the existing waiver authorizing coverage for all childless adults up 100% FPL “would automatically terminate" at the end of 2018.
WI also becomes the 17th state with a waiver to use #Medicaid funds for substance use disorder treatment services in “institutions for mental disease” for all nonelderly Medicaid adults. There’s no explicit day limit, but the state “will aim for” a 30-day statewide average.
For the latest state #Medicaid waiver activity, visit our revamped tracker: kff.org/medicaid/issue…
