Reprinted with permission from GWAAR Legal Services
The Wisconsin Department of Health Services (DHS) recently announced changes to BadgerCare Plus. These changes affect adults ages 19-64 who are not pregnant and who do not have dependent children living with them. On November 1, 2019, DHS mailed information about these changes to current members who are childless adults. Members will receive a separate letter that provides more detail about the changes at their renewal.These changes include:
Emergency room copay – Members are charged a copay of $8 if they visit the ER for care in a situation that is not an emergency. The $8 copay will not apply if the provider determines the visit to be an emergency. The provider’s decision will be based on the patient’s symptoms, rather than the final diagnosis. Please note that federal law requires hospital emergency rooms to screen every patient who seeks emergency care and to stabilize or transfer those with medical emergencies, regardless of health insurance status or ability to pay. BadgerCare Plus members who are tribal members, the child or grandchild of a tribal member, or who qualify for Indian Health Services do not have to pay emergency room copays.
Monthly premiums – BadgerCare Plus members who are childless adults and who have incomes over 50% of the Federal Poverty Level are charged up to $8 each month for their entire household. In 2019, 50% of the Federal Poverty Level was $532 per month for a
household of one or $719 per month for a household of two. Members who do not pay all owed premiums by the end of their certification period will lose eligibility for six months. BadgerCare Plus members who are tribal members, the child or grandchild of a tribal member, or who qualify for Indian Health Services do not have to pay monthly premiums. In addition, members who are homeless, were homeless at any point in the last 12 months, have been residing in a medical institution for at least 30 days, or who have a disability will not have to pay monthly premiums.
Optional health survey – Members are given the option to complete a health survey. If members are required to pay monthly premiums, they can reduce their monthly premium by reporting healthy behaviors like wearing a seatbelt, exercising, and not smoking. Premiums may be reduced to as low as $4 per month based on members’ answers to
this survey.
Treatment needs question – To be eligible for BadgerCare Plus, members must answer a question about their drug use during the last 12 months and, if applicable, their willingness to enter treatment. Their answer will not affect their health care benefits in any way. If an applicant or member does not answer this question, the applicant or member will not be eligible for BadgerCare Plus as a childless adult. Please note that there is no drug test requirement for BadgerCare Plus.
Coverage of residential substance use disorder (SUD) treatment – Federal law use to restrict coverage of SUD treatment in residential facilities for BadgerCare Plus members. However, as of February 1, 2020, SUD treatment in residential facilities are available to all BadgerCare Plus members and other individuals who receive full-benefit Medicaid. This is the only change being made to BadgerCare Plus health care benefits at this time.
These changes went into effect for new applicants as of February 1, 2020. They will affect current BadgerCare Plus members who are childless adults at their next renewal. Both new applicants and current members will be required to pay a copay for any non-emergency visits to the emergency room.
As with all benefits, members should notify their income maintenance agency about any changes in income or family size to determine if their eligibility will change or whether they will be required to pay a premium.
