WEBVTT 00:00.000 --> 00:21.040 Changes to Medicaid eligibility in the One Big Beautiful Bill Act won't take effect 00:21.040 --> 00:25.680 until January, but advocates are worried that new work requirements could put coverage 00:25.680 --> 00:28.280 in jeopardy for many in Wisconsin. 00:28.280 --> 00:32.000 The new changes will apply to those who began receiving Medicaid when Wisconsin partially 00:32.000 --> 00:33.680 expanded the program. 00:33.680 --> 00:38.560 Starting in 2027, this group will have to work, volunteer, or go to school 80 hours 00:38.560 --> 00:40.960 a month to maintain their coverage. 00:40.960 --> 00:45.640 There are exemptions, such as for people considered medically frail, but the rules 00:45.640 --> 00:48.640 to prove that condition just got stricter. 00:48.640 --> 00:53.240 To unpack what this could mean, we're joined by Tammy Jackson from the Wisconsin Board 00:53.240 --> 00:56.120 for People with Developmental Disabilities. 00:56.120 --> 00:57.440 Tammy, thanks so much for joining us. 00:57.440 --> 00:58.440 Thanks for having me. 00:58.440 --> 01:02.280 So I'd like to get a sense of the different groups of people that we're talking about 01:02.280 --> 01:03.280 here. 01:03.280 --> 01:07.480 So first of all, when it comes to people who are subject to these new work requirements 01:07.480 --> 01:13.000 for Medicaid in Wisconsin, how large is that group here, and can you give us a sense of 01:13.000 --> 01:14.000 their circumstances? 01:14.000 --> 01:15.000 Sure. 01:15.000 --> 01:20.080 The group of people that this applies to are folks in the Badger Care Plus program. 01:20.080 --> 01:25.480 Wisconsin actually has many programs that are funded by Medicaid, but it only applies 01:25.520 --> 01:28.360 to the Badger Care Plus population. 01:28.360 --> 01:33.600 And within Badger Care Plus, there are lots of different kinds of people, including some 01:33.600 --> 01:36.960 who we think will be subject to this new rule. 01:36.960 --> 01:42.440 The Department of Health Services estimates about 200,000 people in Badger Care Plus will 01:42.440 --> 01:44.760 be potentially subject to this rule. 01:44.760 --> 01:49.960 And they're worried that about 63,000 are at high risk of losing their coverage. 01:49.960 --> 01:54.240 And many of those people that may be at high risk of losing their coverage are people who 01:54.280 --> 02:01.760 either who may potentially fall into the medically frail exemption, but they may have 02:01.760 --> 02:05.600 a hard time proving that they are exempt. 02:05.600 --> 02:10.720 And the new rule that was just released earlier this month gives some clarity, but also leaves 02:10.720 --> 02:16.320 a lot of questions unanswered for how people qualify to be exempt. 02:16.320 --> 02:21.560 Can you explain that term medically frail as you understood it when this law was passed 02:21.560 --> 02:25.600 and then now as it's being defined in these new federal rules? 02:25.600 --> 02:33.400 Well, the medically frail category in the law had a number of subcategories in it. 02:33.400 --> 02:41.160 And when it was being debated, the law said, well, we intend to, you know, exempt people 02:41.160 --> 02:48.480 with disabilities, people with serious medical conditions, people that you might expect would 02:48.480 --> 02:52.200 have a hard time necessarily meeting a work requirement. 02:52.200 --> 02:58.080 But as it turns out, the way that you proved that you meet one of these categories is harder 02:58.080 --> 02:59.400 than you think. 02:59.400 --> 03:04.560 And it also relies, it's not enough to be able to be in one of the categories. 03:04.560 --> 03:10.160 You also have to prove that you cannot work those 80 hours as in the rule. 03:10.160 --> 03:15.920 So it's kind of a double factor authentication where you have to prove you belong in a category 03:16.000 --> 03:18.520 and you also prove that you can't work. 03:18.520 --> 03:23.520 And this applies to people who are blind and disabled in, you know, that's one exemption 03:23.520 --> 03:24.960 category. 03:24.960 --> 03:30.480 So if somebody who's getting Social Security, SSDI or SSI, another category is people with 03:30.480 --> 03:35.920 serious mental illnesses, a third category is people with physical intellectual developmental 03:35.920 --> 03:41.920 disabilities who have one or difficulty with one or more activities of daily living, and 03:41.920 --> 03:47.480 then people who have a serious illness, a serious medical condition. 03:47.480 --> 03:53.840 And it looks like this rule leaves a lot of questions unanswered both as to who fits 03:53.840 --> 03:58.240 and who doesn't fit in those categories and what happens when you have somebody who's 03:58.240 --> 04:03.920 in that gray area where they can work some, but maybe not as much as 80 hours a month. 04:03.920 --> 04:09.120 I'm just trying to imagine what it means to go through that process if you do fit one 04:09.120 --> 04:11.000 of those categories of proving it. 04:11.000 --> 04:15.560 I mean, what are they going through just to take that step? 04:15.560 --> 04:21.480 Well, and that's part of what is now falling to states to figure out. 04:21.480 --> 04:27.280 The rule will allow you to kind of accept somebody's word for the first year, but after 04:27.280 --> 04:33.720 that, you have to be able to document in an auditable way that you meet these categories. 04:33.720 --> 04:38.560 And I think for many, many states, including our own, there's a mad scramble to try and 04:38.600 --> 04:44.960 figure out, well, how do you prove that you fit into one of these categories? 04:44.960 --> 04:50.880 There are some ideas in the rule about using past billing data, for example, from Medicaid, 04:50.880 --> 04:56.120 but we can see as advocates that there are lots of ways where people might not have access 04:56.120 --> 05:01.640 to the health care system to be able to get the diagnoses or documents they need. 05:01.640 --> 05:06.760 And then it is really unclear how you prove that you cannot work those 80 hours, even 05:06.800 --> 05:08.800 if you fit into those categories. 05:08.800 --> 05:12.680 When this law was passed, I mean, the argument was that taxpayers are going to underwrite 05:12.680 --> 05:13.680 a benefit. 05:13.680 --> 05:17.720 People who receive it should be required to pitch in. 05:17.720 --> 05:22.720 From your perspective, now that it's becoming kind of a reality, what does this miss? 05:22.720 --> 05:27.240 Well, I think the first thing it misses is that two-thirds of the people who are in a 05:27.240 --> 05:30.360 Medicaid program are already working. 05:30.360 --> 05:37.440 So for a lot of people, this now becomes a documentation problem to prove what they 05:37.440 --> 05:39.360 already have been doing. 05:39.360 --> 05:44.960 And for other people who are working part-time, you now have a group of people who has to 05:44.960 --> 05:47.840 do more to keep their coverage. 05:47.840 --> 05:53.680 What we know from other states that have tried similar experiments in the past is that work 05:53.680 --> 05:57.320 requirements don't actually lead to more people working. 05:57.320 --> 06:02.480 What they do lead to is more people making paperwork mistakes or states making paperwork 06:02.480 --> 06:05.320 mistakes that cost people their health care coverage. 06:05.320 --> 06:10.520 And that's particularly serious with the population of people who could qualify to be medically 06:10.520 --> 06:11.520 frail. 06:11.520 --> 06:15.600 If they make a mistake and lose their health care coverage, that could mean that they have 06:15.600 --> 06:20.600 an illness that isn't getting treated, that they lose care coverage that really could 06:20.600 --> 06:22.240 literally cost them their lives. 06:22.240 --> 06:23.240 All right. 06:23.240 --> 06:24.240 Certainly something we'll be watching. 06:24.240 --> 06:26.040 Thanks so much for joining us. 06:26.040 --> 06:26.680 Thanks for having me. 06:27.320 --> 06:28.320 That's fun. 06:28.320 --> 06:29.320 Nice job. 06:29.320 --> 06:30.320 Did it. 06:30.320 --> 06:31.320 Oh my goodness. 06:31.320 --> 06:39.320 I can't even tell you.