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watching the case. Sam Cole,
thank you so much for

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joining us.
>> Thank you.

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>> Changes to Medicaid
eligibility in the One Big

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Beautiful Bill Act won't
take effect until January,

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but advocates are worried
that new work requirements

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could put coverage in
jeopardy. For many in

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Wisconsin, the new changes
will apply to those who

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began receiving Medicaid
when Wisconsin partially

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expanded the program.
Starting in 2027. This

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group will have to work,
volunteer or go to school

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80 hours a month to
maintain their coverage.

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There are exemptions, such
as for people considered

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medically frail, but the
rules to prove that

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condition just got stricter.
To unpack what this could

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mean, we're joined by Tami
Jackson from the Wisconsin

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Board for people with
Developmental Disabilities.

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Tammy, thanks so much for
joining us.

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>> Thanks for having me.
>> So I'd like you to get a

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sense of the different
groups of people that we're

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talking about here. So
first of all, when it comes

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to people who are subject
to these new work

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requirements for Medicaid
in Wisconsin, how large is

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that group here? And can
you give us a sense of

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their circumstances?
>> Sure. The group of

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people that this applies to
are folks in the BadgerCare

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plus program. Wisconsin
actually has many programs

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that are funded by Medicaid,
but it only applies to the

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BadgerCare plus population
and within BadgerCare plus,

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there are lots of different
kinds of people, including

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some who we think will be
subject to this new rule.

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The Department of Health
Services estimates about

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200,000 people in
BadgerCare plus will be

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potentially subject to this
rule, and they're worried

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that about 63,000 are at
high risk of losing their

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coverage. And many of those
people that may be at high

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risk of losing their
coverage are people who

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either who may potentially
fall into the medically

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frail exemption, but they
may have a hard time

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proving that they are
exempt. And the new rule

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that was just released
earlier this month gives

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some clarity, but also
leaves a lot of questions

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unanswered for how people
qualify to be exempt.

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>> Can you explain that
term medically frail as you

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understood it when this law
was passed? And then now,

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as it's being defined in
these new federal rules?

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>> Well, the the medically
frail category in the law

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had a number of
subcategories in it. And

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when it was being debated,
the law said, well, we

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intend to, you know, exempt
people with disabilities,

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people with serious medical
conditions, people that you

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might expect would have a
hard time necessarily

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meeting a work requirement.
But as it turns out, the

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way that you proved that
you meet one of these

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categories is harder than
you think. And it also

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relies it's not enough to
be able to be in one of the

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categories. You also have
to prove that you cannot

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work those 80 hours as in
the rule. So it's kind of a

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double factor
authentication where you

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have to prove you belong in
a category, and you also

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prove that you can't work.
And this applies to people

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who are blind and disabled
in, you know, that's one

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exemption category. So
somebody who's getting

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Social Security, SSDI or
SSI, another category is

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people with serious mental
illnesses. A third category

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is people with physical,
intellectual, developmental

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disabilities who have one
or difficulty with one or

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more activities of daily
living. And then people who

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have a serious or illness,
a serious medical condition.

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And it looks like this rule
leaves a lot of questions

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unanswered, both as to who
fits and who doesn't fit in

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those categories, and what
happens when you have

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somebody who's in that gray
area where they can work

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some, but maybe not as much
as 80 hours a month?

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>> I'm just trying to
imagine what it means to to

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go through that process. If
you do fit one of those

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categories of proving it, I
mean, what, what are they

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going through just to take
that step?

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>> Well, and that's part of
what is now falling to

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states to figure out the
rule will allow you to kind

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of accept somebody's word
for the first year. But

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after that, you have to be
able to document in an

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auditable way that you meet
these categories. And I

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think for many, many states,
including our own, there's

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a mad scramble to try and
figure out, well, how do

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you prove that you fit into
one of these categories?

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There are some ideas in the
rule about using past

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billing data, for example,
from Medicaid. But we can

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see as advocates that there
are lots of ways where

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people might not have
access to the health care

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system to be able to get
the diagnoses or documents

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they need. And then it is
really unclear how you

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prove that you cannot work
those 80 hours, even if you

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fit into those categories.
>> When this law was passed,

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I mean, the argument was
that taxpayers are going to

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underwrite a benefit.
People who receive it

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should be required to pitch
in. From your perspective,

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now that it's becoming kind
of a reality, what does

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this miss?
>> Well, I think the first

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thing it misses is that two
thirds of the people who

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are in a Medicaid program
are already working. So,

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you know, for a lot of
people, this this now

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becomes a documentation
problem to prove what they

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already have been doing.
And for other people who

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are working part time, you
know, you now have a group

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of people who has to do
more to keep their coverage.

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What we know from other
states that have tried

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similar experiments in the
past is that work

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requirements don't actually
lead to more people working.

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What they do lead to is
more people making

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paperwork, mistakes, or
states making paperwork

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mistakes that cost people
their health care coverage.

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And that's particularly
serious with the population

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of people who could qualify
to be medically frail if

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they make a mistake and
lose their health care

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coverage. That could mean
that they have an illness

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that isn't getting treated,
that they lose care

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coverage that really could
literally cost them their