WI Medicaid Waiver Adds Drug Testing, Behavior Incentives
Wisconsin joins other states in submitting a Medicaid waiver to alter rules for beneficiaries, and increase substance abuse testing, incentives for healthy behaviors, and premium payments.
Source: Thinkstock
By - The Wisconsin Department of Health Services (DHS) will submit a section 1115 Medicaid waiver for the 2018 enrollment period that aims to add drug testing, healthy behavior incentives, and premium payments for certain beneficiaries.
The waivers are submitted to HHS, and if approved, allow the state legal flexibility to experiment with test programs and modify existing Medicaid mandates.
Wisconsin will join Maine in submitting a 2018 section 1115 waiver for Medicaid.
Earlier in 2017, HHS Secretary Tom Price sent a letter to the nation’s governors encouraging them to utilize the waiver option to modify Medicaid and other ACA regulations in their state healthcare systems.
The proposed BadgerCare modifications for childless adult beneficiaries include:
Payment of monthly premiums
The premiums will range from $1 to $10 per household based on income. The premium payments will not include households with zero to 20 percent of the federal poverty level.
Wellness incentives
Members who adhere to established healthy behavior protocols could see their premiums reduced by 50 percent. Beneficiaries who continue to engage in specified behaviors that increase their health risk will not be eligible for premium reductions.
Responsible ER usage
Members who use ER services will pay an $8 copay for the first visit, and then a $25 copay for each additional visit over a 12-month period.
Member Health Risk Assessment (HRA)
Members will be requested to complete an HRA. The assessment would ask a series of questions to determine healthy behavior or potential health risks. Although not a requirement for coverage, members will pay full Medicaid premiums until the HRA is completed.
Time limit for coverage eligibility
This proposed change would limit Medicaid coverage to beneficiaries for a 48 month period. After the 48 months, Medicaid coverage would be suspended for six months.
The 48-month coverage period will not apply to members who are participants in the 80 hours a month employment/training program. The time limit applies only to members aged 19-49.
Individuals with mental illness, disabilities, full-time students, and those over the of age 49 are also exempt.
Substance abuse screening and treatment
Acknowledging the public health epidemic of Substance Use Disorder (SUD), this waiver proposal will require applicants to complete a drug screening and test. If an individual tests positive for drug use, they will not be denied benefits, but they will be referred to an SUD treatment program.
If a member refuses to complete the drug assessment or test, they will be denied benefits until they do so. A member who tests positive and refuses to participate in a SUD treatment program will result in a six-month ineligible period.
Residential treatment coverage for SUD
The waiver proposal would make federal Medicaid funding available to reimburse SUD treatment costs at qualified institutions.
To achieve this goal, the state is requesting an exclusion for treatment reimbursement, and a waiver of the 15-day limit for SUD coverage as outlined in Medicaid managed care regulations.
