Changes to Medicaid eligibility in
the One Big Beautiful Bill Act won't
take effect until January,
but advocates are worried that new
work requirements could put coverage
in jeopardy for many in Wisconsin.
The new changes will apply to those
who began receiving Medicaid when
Wisconsin partially expanded the
program. Starting in 2027,
this group will have to work,
volunteer, or go to school 80 hours
a month to maintain their coverage.
There are exemptions,
such as for people considered
medically frail.
But the rules to prove that
condition just got stricter.
To unpack what this could mean,
we're joined by Tammy Jackson from
the Wisconsin Board for People with
Developmental Disabilities.
Tammy, thanks so much for joining
us. Thanks for having me.
So I'd like you to get a sense of
the different groups of people that
we're talking about here.
So first of all, when it comes to
people who are subject to these new
work requirements for Medicaid in
Wisconsin, how large
is that group here?
And can you give us a sense of their
circumstances?
Sure, the group of people that
this applies to are folks in the
BadgerCare Plus program.
Wisconsin actually has many programs
that are funded by Medicaid, but
it only applies to the
Badgecare Plus population.
And within Badgercare Plus, there
are lots of different kinds of
people, including some
who we think will be subject
to this new rule.
The Department of Health Services
estimates about 200,000
people in Badger Care Plus will
be potentially subject to this rule.
And they're worried that about
63,000 are at high risk
of losing their coverage.
And many of those people that may be
at high risk of losing coverage are
people who either,
who may potentially fall
into the medically frail
exemption but they may have
a hard time proving that
they are exempt.
And the new rule that was just
released earlier this month gives
some clarity but also leaves a
lot of questions unanswered
for how people qualify
to be exempt.
Can you explain that term medically
frail as you understood it
when this law was passed
and then now as it's being defined
in these new federal rules?
Well, the medically frail
category in the law had
a number of subcategories in it.
And when it was being debated,
the law said, well, we intend to,
you know, it.
Exempt people with disabilities,
people with serious medical
and conditions,
people that you might expect
would have a hard time necessarily
meeting a work requirement.
But as it turns out, the
way that you proved that you meet
one of these categories is harder
than you think.
And it also relies, it's
not enough to be able to be in
one of the categories.
You also have to prove that you
cannot work those 80 hours
as in the rule.
So it's kind of a double-factor
authentication where you
have to prove you belong in a
category and you also prove that you
can't work.
And this applies to people who
are blind and disabled.
That's one exemption category.
So if somebody who's getting Social
Security, SSDI or
SSI, another category is
people with serious mental
illnesses.
A third category is people with
physical intellectual developmental
disabilities who have difficulty
with one or more.
Activities of daily living,
and then people who have a serious
illness, a serious
medical condition.
And it looks like this rule
leaves a lot of questions
unanswered, both as to who
fits and who doesn't fit in those
categories, and what happens when
you have somebody who's in that gray
area where they can work some,
but maybe not as much as
80 hours a month.
I'm just trying to imagine what it
means to go
through that process if you do fit
one of those categories of proving
it. I mean, what
are they going through just to take
that step?
Well, and that's part of what is
now falling to states to figure
out.
The rule will allow
you to kind of accept somebody's
word for the first year, but after
that, you have to be able
to document in an auditable
way that you meet these categories.
And I think for many, many states,
including our own, there's a mad
scramble to try and figure out,
well, how do you prove that
you fit into one of these
categories?
There are some ideas in the
rule about using past billing
data, for example, from Medicaid,
but we can see as advocates that
there are lots of ways where people
might not have access to the health
care system to be able to get
the diagnoses or documents they
need, and then it is really
unclear how you prove that
you cannot work those 80 hours,
even if you fit into those
categories.
When this law was passed, the
argument was that taxpayers
are going to underwrite a benefit.
People who receive it should be
required to pitch in.
From your perspective, now that
it's becoming kind of a reality,
what does this miss?
Well, I think the first thing it
misses is that two-thirds of the
people who are in a Medicaid program
are already working.
So, you know,
for a lot of people, this now
becomes a documentation problem
to prove what they already have been
doing. And for other
people who were working part-time,
you now have a group of people who
has to do more to keep their
coverage. What we know from...
Other states that have tried similar
experiments in the past, is
that work requirements don't
actually lead to more people
working. What they do lead to
is more people making paperwork
mistakes or states making paperwork
mistakes that cost people their
health care coverage.
And that's particularly serious
with the population of people
who could qualify to be medically
frail. If they make a mistake
and lose their health-care coverage,
that could mean that have an illness
that isn't getting treated.
That they lose care coverage
that really could literally cost
them their lives.
Certainly something we'll be
watching. Thanks so much for joining
us.
Thanks for having me.
Hey, that's fun nice job
did it.
Oh my goodness.
I can't even tell you