Wisconsin receives approval for Medicaid work requirements

Joining a handful of other states, Wisconsin’s waiver to implement Medicaid work requirements has been approved by CMS, the agency announced today.

The Badger State joins Indiana, Arkansas and New Hampshire as having approval to implement work requirements, which will require a certain population of the state’s Medicaid beneficiaries to report qualified work activities every month––or face losing coverage.

Wisconsin is the first state to receive approval for work requirements that did not expand Medicaid under the Affordable Care Act. All other states with approved waivers for such programs did expand Medicaid under the healthcare law, meaning Wisconsin could limit healthcare coverage to fewer people prior to the ACA’s passage.

Work requirement programs have been met with intense backlash, including several legal challenges. A judge blocked a work requirement program from being implemented in Kentucky, while HHS is facing a broader lawsuit from the National Health Law Program and others.

Recent studies have indicated that work requirement policies, if implemented nationally, could kick millions off of healthcare coverage. However, the savings to Medicaid wouldn’t be that great because the most vulnerable people, including the sickest and most expensive beneficiaries, wouldn’t be impacted.

CMS maintains that work requirements encourage individuals to find employment. The agency refers to work requirements as “community engagement” programs. The Trump administration only started allowing work requirement waivers to be approved at the start of 2018.

“We will not retreat from this position,” CMS Administrator Seema Verma stated in a blog post, addressing the controversy over the programs.

A motivated and strong economy can spell good news for those who may be affected by the work requirements, as well, Verma noted.

“…There are real, life-changing opportunities available to help lift individuals out of the shadows of opportunity and into its light,” Verma wrote. “States rightly want to explore innovative ways to achieve that objective.”

In Arkansas, which was the first state to implement work requirements in June, thousands have already lost coverage due to noncompliance with the program. Part of the problem with the changes is that beneficiaries may not be fully aware of the impact.

The approval also comes within a week of the midterm election, where Republican Wisconsin Governor Scott Walker is facing reelection. If Walker loses, Democrat challenger Tony Evers could potentially withdraw the waiver for the state. Evers has stated his support to expand Medicaid.

Wisconsin has already imposed other changes to Medicaid, including charging monthly premiums of up to $8 per month and $8 co-payments for emergency room visits for non-emergencies. Individuals can also be locked out of coverage if they fail to pay their fees, The Hill reported.

Under the new waiver, Wisconsin Medicaid beneficiaries ages 19 through 49 will have to report and document 80 hours per month of work, job training or community engagement activities. The program only impacts non-pregnant, non-disabled, childless adults with income up to and including 100 percent of the federal poverty line.

Walker, however, did not get approval to drug test Medicaid beneficiaries, which he had asked for in the waiver to CMS.