Initial Medicaid Implementation: Wisconsin first implemented Medicaid in July of 1966, one of the first opportunities for a state to begin their Medicaid program. The state previously ran a program under the Kerr-Mills legislation. The state paid the most monthly per beneficiary on medical care at $43.93. When Medicaid was enacted, 6.3% of the population or 262,000 people became eligible for Medicaid coverage. The state was home to the architect of the Medicaid program, HEW Secretary Wilbur Cohen. Cohen later returned to the University of Wisconsin, Madison where he wrote about the early years of the Medicaid program.
Key Medicaid Political Issues: In July of 1999 the state launched BadgerCare. The program was originally aimed at children who were transitioning off of welfare benefits following the 1996 federal reforms to welfare. Families could enroll if their incomes were less than 185% poverty and if their income fluctuated and rose to less than 200% of poverty, they could remain in the program. There was no asset test for qualification. In 2006 a proposal entitled “Healthy Wisconsin” would have expanded BadgerCare similar to how Massachusetts expanded coverage and would mandate insurance coverage. The program was unpopular among the Republican controlled Assembly and the Democratic Governor Jim Doyle. As a compromise Doyle expanded BadgerCare to all uninsured children, more pregnant women, and parents. The changes coincided with the 2009 Recession and saw a higher number of applications than the state expected. The state suspended applications in response to this demand and put 21,000 individuals on the waiting list. The Governor proposed creating a program called BadgerCare+ Basic for childless adults. The applicants would be required to pay a premium and there would be limits on doctor, hospital, outpatient and ER visits. Certain drugs would also be limited.
Medicaid Expansion Implementation: As of April 2019, Wisconsin has not implemented the Medicaid expansion. In 2015 the state’s 1115 waiver that allowed the previous BadgerCare+ program was due to expire. The state received a waiver extension to continue the program but were required to eliminate the waiting lists and limits on coverage to continue to receive federal funding but not take the Medicaid expansion. The state does not receive the enhanced federal funding for the expansion population. The state was resistant to passing Medicaid expansion under then Republican governor Scott Walker and a Republican legislature. The state received an 1115 waiver in 2018 from the Trump administration to add work requirements to the existing eligible adult Medicaid population. The original plan also included a policy that would require the state to drug screen potential Medicaid beneficiaries. This portion of the waiver was not improved, particularly because the Medicaid program is one of the primary payers of opioid use disorder treatment. In November of 2018 the state elected a Democratic governor who ran against the changes outlined by the waiver. The legislature met during the lame duck legislative session and required the state to maintain the work requirements that had been submitted and approved by the former governor.
General facts about Wisconsin Medicaid:
Medicaid program name: Medicaid (certain programs are called BadgerCare).
CHIP Program name: Badgercare Plus
Separate or combined CHIP: Combination
Medicaid Enrollment: 1.02 million (December 2018 estimate)
Total Medicaid Spending: $8.1 billion (FY 2017 estimate)
Share of total population covered by Medicaid: 16%
Share of Children covered by Medicaid: 33% (estimate)
Share of Medicaid that is Children and Adults: 72%
Share of Spending on Elderly and people with disabilities: 69%
Share of Nursing Facility Residents covered by Medicaid: 55.6%
Expansion state: No
Number of people in expansion: N/A
Work Requirement: Yes, although not implemented