Wisconsin, tweaks, but doesn’t retreat from controversial Medicaid waiver

Wisconsin has revised its controversial waiver requiring Medicaid members to pay premiums and undergo a drug screening to participate in the program, after receiving criticism from the public.

The Wisconsin Department of Health Services submitted its Medicaid waiver application Wednesday to the CMS after incorporating more feedback in more than 1,000 comments on the original proposal.
“This application is a step in the right direction, and we’re continuing to build on Wisconsin’s legacy as a leader in welfare reform,” Republican Gov. Scott Walker said in a statement.
The state received strong criticism against its plan to impose premiums on individuals who fall below the poverty line. There were concerns that people with incomes as low as 20% of the federal poverty level would not be able to afford paying the monthly premiums of any amount.
Originally, the state had outlined a sliding scale where people between 20% and 100% of federal poverty level would pay between $1 and $10 a month. It scrapped those plans and is now proposing no one below 51% of the poverty line will pay any premium. Those above that level will pay $8 a month.
The state has also softened its plan to charge Medicaid members who visit the emergency room an $8 copay for the first visit and a $25 copay for subsequent visits over a yearlong period. The requirement was meant to encourage members to use healthcare services appropriately, the state’s Department of Health Services said.
However, commenters cried foul as people with multiple chronic conditions, cancer, HIV/AIDS and low-income beneficiaries are more likely to need ED care due to their conditions.
Instead of jettisoning the co-pay proposal, Wisconsin modified it to $8 for any ER visit.
The state also is tweaking the requirement that people be drug tested as a condition to be eligible for Medicaid. Commenters complained that drug screening and testing are unlawful and ineffective ways to identify individuals with substance use disorder. They said that implementing this requirement as a condition of eligibility further stigmatizes substance use disorders and and will be a barrier to individuals obtaining healthcare coverage.
Instead, Wisconsin will allow individuals who express a desire to enter treatment on the screening questionnaire to skip the drug test and enter treatment and gain coverage. Those who outright refuse to be tested will be ineligible for coverage but may reapply for benefits at any time once they are willing to comply.
Wisconsin did not modify its work requirement proposal or its plan to limit Medicaid eligibility to 48 months, unless the beneficiary is employed or in a training program.
Once the CMS posts the waiver on its webpage, it will undergo a 30-day comment period.