WI – Budget Committee Approves Drug Screening for Medicaid Applicants

June 2017 ~

Wisconsin’s state budget committee, in a 12-4 vote, has approved a proposal that will require able-bodied, childless adults to undergo drug screening when applying for Medicaid health benefits through the state’s BadgerCare program.

Following the release of the draft Section 1115 Demonstration Waiver amendment application in April, DHS gathered feedback and revisions were made reflecting comments from Wisconsin citizens. Core changes included in WI’s waiver amendment application are as follows:

  • Monthly Premiums and Co-payments for Emergency Department Visits
    • For premiums, there will be two income tiers instead of four. Childless adults with household incomes of zero to 50% of the federal poverty level (FPL) will not pay a premium, and those with household incomes of 51 to 100% of the FPL will pay an $8 monthly premium;
    • The emergency department co-payment for childless adults will be $8 for each visit. The original draft application had an $8 co-payment for the first visit to the emergency department and a $25 payment for each subsequent visit in a 12-month period;
  • Work Requirements
    • Members must work or participate in job skills training at least 80 hours every month.
  • Limits Timeframe of Benefits
    • Benefits will be limited to a 48 month period, unless a member meets a work requirement;
  • Healthy Behavior Incentives
    • Rewards healthy behaviors by establishing lower premiums for members who make healthy choices;
  • Drug Screening and Testing
    • Beneficiaries who test positive will be offered treatment so they can get healthy;
    • If a member refuses to consent to substance use disorder treatment, instead of being ineligible for BadgerCare Plus benefits for six months, an individual may reapply at any time the individual consents to the treatment;
    • A drug test will not be required for childless adults who indicate on their drug screening assessment that they are ready to enter a substance use disorder treatment program. Members may be required to take a drug test as part of their substance use disorder treatment.
  • Expands Access to Treatment
    • Establishment of a new residential substance use disorder treatment benefit to allow coverage of medically necessary residential substance use disorder treatment services for up to 90 days for all BadgerCare Plus and Medicaid members.

The work requirements, drug testing, and time limit provisions included in the state’s waiver have not been approved in any state. Historically, CMS has not approved state waiver requests to require that Medicaid beneficiaries work as a condition of eligibility, on the basis that such a provision would not further the program’s purposes of promoting health coverage and access. If approved, WI will be the first state in the nation to mandate the drug screening of childless individuals applying for state medical assistance.

More information is available about the BadgerCare Reform Demonstration Waiver can be found here.


Source(s): Leavitt Partners; U.S. News; The New York Times; HealthPayerIntelligence;