Wisconsin Medicaid beneficiaries could face drug testing, new premiums and copays, and work requirements if the Centers for Medicare & Medicaid Services approves a waiver for the state’s demonstration program.
The state, which did not expand Medicaid under the Affordable Care Act, is also proposing healthy behavior incentives—and penalties for behaviors that increase health risks.
The substance abuse identification and treatment provision would require individuals to complete a drug screening assessment and, “if indicated,” undergo a drug test. It would be the first state to enact a drug testing provision.
Republican Governor Scott Walker mentioned the move earlier this year in a budget address. "We’re working with the new administration and Congress to get approval to expand drug testing for people seeking public assistance," he said. "If they fail the test, we provide treatment to get them healthy and back into the work force."
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Individuals won’t lose eligibility for the state’s Medicaid program, called BadgerCare, if they test positive; instead they’ll be referred to a substance abuse treatment program.
But members who do not complete a drug screening assessment or drug test will be ineligible for benefits until the requirement is completed. Refusal to participate in a treatment program will result in ineligibility for benefits for six months.
The state says it will expand coverage of substance abuse treatment—but it's asking for federal Medicaid funding to help.
Other proposed changes—all of which must be approved by CMS—include monthly premiums “to increase the sustainability and value of healthcare in the state” will range from $1 to $10 per household according to household income. Members with household incomes of 20% or less of the federal poverty level will not have a monthly premium.
Some fear that even small increases in premiums could be a barrier to coverage. Wisconsin Council on Children and Families research director Jon Peacock told The Badger Herald that the waiver would impede Wisconsin’s overall goal to expand Wisconsin’s workforce, eliminate the coverage gap in the state’s health care system and cut the number of uninsured people.
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Healthy behavior incentives could reduce monthly premiums by 50%.
On the other hand, those engaged in behaviors that increase their health risk will owe the full standard premium.
Members must also fill out a Health Risk Assessment questionnaire “that will be used to identify healthy behavior and health risks for improved understanding of the health needs of members.” It’s not a condition of eligibility, but members will pay the full standard premium until they complete the HRA.
Beneficiaries could also pay escalating emergency room visit copays to “promote appropriate use of healthcare services and behavior that is mindful of health care value.” The first ER visit would cost recipients $8; the copay rises to $25 for subsequent visits in a 12-month period.
The state is also proposing a 48-month eligibility limit for members. After 48 months of enrollment, a member will not be eligible for healthcare benefits for six months with some exceptions, including for disabled beneficiaries and those who are working or participating in an employment and training program.