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Changes to Medicaid eligibility in

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the One Big Beautiful Bill Act won't

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take effect until January,

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but advocates are worried that new

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work requirements could put coverage

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in jeopardy for many in Wisconsin.

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The new changes will apply to those

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who began receiving Medicaid when

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Wisconsin partially expanded the

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program. Starting in 2027,

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this group will have to work,

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volunteer, or go to school 80 hours

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a month to maintain their coverage.

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There are exemptions,

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such as for people considered

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medically frail.

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But the rules to prove that

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condition just got stricter.

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To unpack what this could mean,

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we're joined by Tammy Jackson from

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the Wisconsin Board for People with

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Developmental Disabilities.

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Tammy, thanks so much for joining

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us. Thanks for having me.

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So I'd like you to get a sense of

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the different groups of people that

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we're talking about here.

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So first of all, when it comes to

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people who are subject to these new

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work requirements for Medicaid in

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Wisconsin, how large

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is that group here?

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And can you give us a sense of their

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circumstances?

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Sure, the group of people that

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this applies to are folks in the

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BadgerCare Plus program.

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Wisconsin actually has many programs

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that are funded by Medicaid, but

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it only applies to the

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Badgecare Plus population.

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And within Badgercare Plus, there

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are lots of different kinds of

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people, including some

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who we think will be subject

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to this new rule.

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The Department of Health Services

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estimates about 200,000

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people in Badger Care Plus will

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be potentially subject to this rule.

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And they're worried that about

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63,000 are at high risk

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of losing their coverage.

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And many of those people that may be

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at high risk of losing coverage are

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people who either,

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who may potentially fall

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into the medically frail

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exemption but they may have

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a hard time proving that

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they are exempt.

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And the new rule that was just

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released earlier this month gives

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some clarity but also leaves a

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lot of questions unanswered

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for how people qualify

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to be exempt.

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Can you explain that term medically

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frail as you understood it

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when this law was passed

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and then now as it's being defined

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in these new federal rules?

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Well, the medically frail

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category in the law had

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a number of subcategories in it.

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And when it was being debated,

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the law said, well, we intend to,

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you know, it.

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Exempt people with disabilities,

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people with serious medical

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and conditions,

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people that you might expect

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would have a hard time necessarily

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meeting a work requirement.

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But as it turns out, the

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way that you proved that you meet

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one of these categories is harder

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than you think.

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And it also relies, it's

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not enough to be able to be in

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one of the categories.

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You also have to prove that you

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cannot work those 80 hours

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as in the rule.

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So it's kind of a double-factor

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authentication where you

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have to prove you belong in a

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category and you also prove that you

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can't work.

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And this applies to people who

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are blind and disabled.

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That's one exemption category.

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So if somebody who's getting Social

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Security, SSDI or

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SSI, another category is

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people with serious mental

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illnesses.

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A third category is people with

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physical intellectual developmental

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disabilities who have difficulty

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with one or more.

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Activities of daily living,

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and then people who have a serious

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illness, a serious

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medical condition.

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And it looks like this rule

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leaves a lot of questions

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unanswered, both as to who

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fits and who doesn't fit in those

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categories, and what happens when

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you have somebody who's in that gray

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area where they can work some,

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but maybe not as much as

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80 hours a month.

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I'm just trying to imagine what it

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means to go

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through that process if you do fit

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one of those categories of proving

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it. I mean, what

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are they going through just to take

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that step?

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Well, and that's part of what is

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now falling to states to figure

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out.

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The rule will allow

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you to kind of accept somebody's

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word for the first year, but after

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that, you have to be able

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to document in an auditable

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way that you meet these categories.

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And I think for many, many states,

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including our own, there's a mad

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scramble to try and figure out,

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well, how do you prove that

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you fit into one of these

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categories?

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There are some ideas in the

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rule about using past billing

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data, for example, from Medicaid,

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but we can see as advocates that

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there are lots of ways where people

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might not have access to the health

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care system to be able to get

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the diagnoses or documents they

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need, and then it is really

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unclear how you prove that

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you cannot work those 80 hours,

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even if you fit into those

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categories.

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When this law was passed, the

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argument was that taxpayers

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are going to underwrite a benefit.

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People who receive it should be

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required to pitch in.

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From your perspective, now that

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it's becoming kind of a reality,

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what does this miss?

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Well, I think the first thing it

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misses is that two-thirds of the

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people who are in a Medicaid program

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are already working.

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So, you know,

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for a lot of people, this now

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becomes a documentation problem

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to prove what they already have been

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doing. And for other

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people who were working part-time,

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you now have a group of people who

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has to do more to keep their

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coverage. What we know from...

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Other states that have tried similar

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experiments in the past, is

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that work requirements don't

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actually lead to more people

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working. What they do lead to

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is more people making paperwork

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mistakes or states making paperwork

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mistakes that cost people their

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health care coverage.

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And that's particularly serious

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with the population of people

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who could qualify to be medically

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frail. If they make a mistake

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and lose their health-care coverage,

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that could mean that have an illness

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that isn't getting treated.

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That they lose care coverage

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that really could literally cost

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them their lives.

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Certainly something we'll be

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watching. Thanks so much for joining

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us.

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Thanks for having me.

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Hey, that's fun nice job

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did it.

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Oh my goodness.

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I can't even tell you