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Changes to Medicaid eligibility in the One Big Beautiful Bill Act won't take effect

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until January, but advocates are worried that new 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 who began receiving Medicaid when Wisconsin partially

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expanded the program.

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Starting in 2027, this group will have to work, volunteer, or go to school 80 hours

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a month to maintain their coverage.

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There are exemptions, such as for people considered medically frail, but the rules

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to prove that condition just got stricter.

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To unpack what this could mean, we're joined by Tammy Jackson from the Wisconsin Board

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for People with Developmental Disabilities.

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Tammy, thanks so much for joining us.

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Thanks for having me.

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So I'd like to get a sense of the different groups of people that we're talking about

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here.

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So first of all, when it comes to people who are subject to these new work requirements

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for Medicaid in Wisconsin, how large is that group here, and can you give us a sense of

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their circumstances?

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Sure.

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The group of people that this applies to are folks in the Badger Care Plus program.

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Wisconsin actually has many programs that are funded by Medicaid, but it only applies

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to the Badger Care Plus population.

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And within Badger Care Plus, there are lots of different kinds of people, including some

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who we think will be subject to this new rule.

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The Department of Health Services estimates about 200,000 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 63,000 are at high risk of losing their coverage.

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And many of those people that may be at high risk of losing their coverage are people who

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either who may potentially fall into the medically frail exemption, but they may have

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a hard time proving that they are exempt.

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And the new rule that was just released earlier this month gives some clarity, but also leaves

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a lot of questions unanswered for how people qualify to be exempt.

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Can you explain that term medically frail as you understood it when this law was passed

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

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Well, the medically frail category in the law had a number of subcategories in it.

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And when it was being debated, the law said, well, we intend to, you know, exempt people

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with disabilities, people with serious medical conditions, people that you might expect would

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have a hard time necessarily meeting a work requirement.

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But as it turns out, the way that you proved that you meet one of these categories is harder

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than you think.

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And it also relies, it's not enough to be able to be in one of the categories.

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You also have to prove that you cannot work those 80 hours as in the rule.

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So it's kind of a double factor authentication where you have to prove you belong in a category

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and you also prove that you can't work.

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And this applies to people who are blind and disabled in, you know, that's one exemption

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category.

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So if somebody who's getting Social Security, SSDI or SSI, another category is people with

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serious mental illnesses, a third category is people with physical intellectual developmental

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disabilities who have one or difficulty with one or more activities of daily living, and

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then people who have a serious illness, a serious medical condition.

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And it looks like this rule leaves a lot of questions unanswered both as to who fits

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and who doesn't fit in those categories and what happens when you have somebody who's

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in that gray area where they can work 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 go through that process if you do fit one

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of those categories of proving it.

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I mean, what are they going through just to take that step?

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Well, and that's part of what is now falling to states to figure out.

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The rule will allow you to kind of accept somebody's word for the first year, but after

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that, you have to be able to document in an auditable way that you meet these categories.

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And I think for many, many states, including our own, there's a mad scramble to try and

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figure out, well, how do you prove that you fit into one of these categories?

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There are some ideas in the rule about using past billing data, for example, from Medicaid,

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but we can see as advocates that there are lots of ways where people might not have access

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to the health care system to be able to get the diagnoses or documents they need.

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And then it is really unclear how you prove that you cannot work those 80 hours, even

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if you fit into those categories.

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When this law was passed, I mean, the argument was that taxpayers are going to underwrite

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a benefit.

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People who receive it should be required to pitch in.

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From your perspective, now that it's becoming kind of a reality, what does this miss?

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Well, I think the first thing it misses is that two-thirds of the people who are in a

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Medicaid program are already working.

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So for a lot of people, this now becomes a documentation problem to prove what they

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already have been doing.

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And for other people who are working part-time, you now have a group of people who has to

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do more to keep their coverage.

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What we know from other states that have tried 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 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 of people who could qualify to be medically

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frail.

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If they make a mistake and lose their health care coverage, that could mean that they have

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an illness that isn't getting treated, that they lose care coverage that really could

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literally cost them their lives.

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All right.

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Certainly something we'll be watching.

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Thanks so much for joining us.

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Thanks for having me.

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That's fun.

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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.