The Centers for Medicare & Medicaid Services (CMS) has approved Wisconsin’s Section 1115 waiver, which includes work and community engagement requirements as a condition of Medicaid eligibility for certain enrollees.
Wisconsin is the fifth state to receive approval this year to implement work requirements, following Kentucky, Indiana, Arkansas, and New Hampshire.
The waiver enables Wisconsin to expand its Medicaid program, as allowed under the Affordable Care Act (ACA), to childless adults that meet certain income thresholds. Adults in this new expansion group will be required to participate in, document, and report 80 hours per month of employment, job training, community service, or enrollment in an allowable work program. Enrollees subject to the work requirement will have 48 months to come into compliance; failure to do so will result in disenrollment from the program for six months. The work requirements are consistent with the state’s Supplemental Nutritional Assistance Program (SNAP) requirements and do not apply to beneficiaries age 50 and older.
Wisconsin’s waiver also requires childless adults to:
- pay premiums as a condition of eligibility;
- respond to a health risk assessment, which the state may use to vary premiums; and
- pay a copayment for non-emergency use of the emergency department.
CMS did not approve Wisconsin’s request to require drug testing as a condition of eligibility.
Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.
