Wisconsin: Medicaid Buy-In

Wisconsin: Medicaid Buy-In

Upshot

  • A.B. 1118 and S.B. 1089 proposed the creation of a basic health plan, a buy-in option under Medicaid, and the implementation of a state-based Marketplace.

  • BadgerCare currently covers all children up to age 18, low-income pregnant women and parents, farm families, and adults with incomes up to the FPL.

  • The bills were introduced by Democrats in the Republican-controlled legislature at the very end of the legislative session and died when the legislature adjourned.

Background

Wisconsin is one of 12 states that has not expanded Medicaid under the ACA to adults without dependent children. However, it currently provides Medicaid benefits to a segment of the population that would otherwise benefit from a Medicaid expansion. Through a Section 1115 waiver, Wisconsin operates BadgerCare, which provides Medicaid benefits to childless adults who are not pregnant, disabled, or elderly individuals with incomes of up to and including 100 percent FPL. The waiver allows Wisconsin to expand eligibility criteria and implement additional features, such as charging a monthly premium to beneficiaries with incomes from 50 percent and up to and including 100 percent FPL. Notably, Wisconsin attempted to impose work requirements through its Section 1115 waiver approved by the Trump Administration, though it was ultimately withdrawn by the Biden Administration. BadgerCare is funded through a combination of Medicaid, CHIP, and state-only funds.

Additionally, Wisconsin offers Medicaid Purchase Plan, a Medicaid buy-in for adults with a disability who 1) have a job or are enrolled in the certified Health and Employment Counseling Program, 2) have individual countable assets of $15,000 or less, and 3) have an income of less than 250 percent FPL. Beneficiaries with a gross monthly income at or below 100 percent FPL do not have to pay a monthly premium.

Wisconsin leverages the federally-facilitated Marketplace. In 2022, 14 insurers offered plans on the Marketplace. Overall, average premiums decreased by 0.65 percent from the previous year. The ARP APTC expansion has been particularly impactful in Wisconsin. In 2021, the average monthly premium in Wisconsin was $629 without subsidies and $185 with subsidies. Wisconsin also operates Wisconsin Healthcare Stability Plan, a reinsurance program, through a section 1332 waiver, which lowered premiums by 13.4 percent in 2021.

Summary

The bills would require the Wisconsin Department of Health (DHS) to establish: 1) a basic health plan for individuals with income up to 200 percent FPL and 2) a Medicaid buy-in for individuals with income above 200 percent FPL as well as a limited pathway for employers. In order to facilitate the buy-in option, the bill would also require the establishment and operation of a state-based health insurance Marketplace. Currently, Wisconsin uses the federally-facilitated Marketplace to offer ACA Marketplace plans.

  • Basic Health Plan: The bill would require the Wisconsin Department of Health Services (DHS) to request federal approval to create a BHP for individuals with incomes up to 200 percent FPL.

  • Medicaid Buy-in: Additionally, the bill would require a purchase option for BadgerCare for individuals with income above 200 percent FPL. There would also be an option for small groups of 50 employees or fewer to purchase coverage for group members. The purchase option must include the following attributes:

    • Establishment of an annual per enrollee premium rate similar to the average rate paid by the state to managed care plan contractors

    • Establishment of a benefit set equal to benefits covered by Medicaid;

    • Annual enrollment that is limited to the same annual open enrollment periods established for Medicaid;

    • The ability for the department to adjust the actuarial value to a value no lower than 87 percent; and

    • Reimbursement mechanisms for addressing potential increased costs to state health programs.

DHS would be required to submit a report with information on the status of receiving a federal waiver and the results of any economic analyses. DHS would also be required to seek any federal waiver and Medicaid plan amendments necessary to allow individuals who buy into BadgerCare to use advanced tax credits and cost-sharing credits.