As of right now, 38 states (including DC) have expanded Medicaid, while 13 have not. Medicaid expansion through the provisions of the Affordable Care Act (ACA) remains a hot button issue within the states that have not implemented it. Some of these states seek to find an alternative route for providing healthcare to residents, though this process has been long and complicated. However, Wisconsin is unique among these states in the fact that it has not implemented expansion, but still has a fairly successful state program that provides for people in the coverage gap.
Current State of Wisconsin Medicaid
Wisconsin Medicaid remains much the same as it has since before the implementation of the ACA. Pregnant women, children and some parents/caretakers are eligible for coverage, but few others. In October 2018, the Center for Medicare & Medicaid Services (CMS) approved a waiver that would expand Medicaid coverage to childless adults who live at 95 percent of the federal poverty line (FPL). A work/community engagement requirement of 80 hours per month for nonexempt adults under 50 without children was included with this waiver. The number of adults expected to receive this coverage is over 178,000.
As of Spring 2020, 1,042,139 Wisconsin residents were enrolled in Medicaid or CHIP (Children’s Health Insurance Program). However, because Wisconsin has not expanded Medicaid, it only receives a regular federal match rate of 58.5 percent, as opposed to the 90 percent that it could get with federal funding. One current estimate claims that if Wisconsin were to expand Medicaid coverage, 120,000 more people would gain access to it, and the uninsured rate would fall by 16 percent. As of right now, however, Medicaid expansion through the ACA remains unlikely. This is due in part to Wisconsin lawmakers’ confidence in their state program.
Wisconsin is the only state that has not expanded Medicaid and yet has no coverage gap (the nonexempt adult population that lives below the poverty line). This is a result of BadgerCare, a state program that provides subsidies to help residents purchase private insurance plans. As of May 2020, 175,893 adults without disabilities or minor children have coverage through this plan (which is a 23,000-person increase from March due to the effects of the COVID-19 crisis). Essentially, this program provides state-funded healthcare in the place of expanded Medicaid, which is something that no other state does.
BadgerCare determines how Wisconsin’s state-subsidized program operates, but it also governs the state’s use of Medicaid. For instance, the abovementioned Medicaid waiver is operated under the BadgerCare program, and was expected to be implemented in 2020. However, this has been put on hold in order that the state can receive more federal Medicaid assistance to react to the COVID-19 pandemic. For the foreseeable future, this program will continue to be Wisconsin’s answer to Medicaid expansion.
How We Can Help
At DECO, our goals are to help healthcare organizations get reimbursed for the care they have provided and help patients find security in being able to pay their bills. To do this, we look at whatever insurance programs patients might be eligible for and walk them through the process of applying. Whether that solution is Medicaid, a Marketplace private insurance plan or anything else, we’re here to help streamline and add clarity to the eligibility process. For more information, contact us today!