watching the case. Sam Cole, thank you so much for
joining us. >> Thank you.
>> 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 Tami 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
BadgerCare 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 BadgerCare 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 their 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 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, exempt people with disabilities,
people with serious medical 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 in, you know, that's one
exemption category. So 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 one or difficulty with one or
more activities of daily living. And then people who
have a serious or 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 to
go through that process. If you do fit one of those
categories of proving it, I mean, what, 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,
I mean, 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 this now
becomes a documentation problem to prove what they
already have been doing. And for other people who
are working part time, you know, 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 they have an illness
that isn't getting treated, that they lose care
coverage that really could literally cost them their