Beginning in February, Wisconsin will start implementing changes to BadgerCare (Wisconsin’s Medicaid program for low-income families) that make health care less accessible for low-income Wisconsinites who do not have children. Medicaid helps people with disabilities, older adults, children and parents with low-wage jobs, and adults who are struggling to make ends meet get the health care they need.

There are already about 300,000 Wisconsin residents who don’t have health insurance, and many thousands more cannot afford the health care they need. The changes to BadgerCare will exacerbate the problem and will disproportionally impact communities of color.

Starting February 1, adults ages 19-64 who aren’t pregnant and don’t have dependent children (i.e. childless adults) will be required to pay monthly premiums, charged copays for using the emergency room in certain instances, and must respond to questions related to drug use and treatment. These changes, which are part of a larger effort begun by the Walker administration and mandated by the legislature, create additional hurdles and red tape for childless adults who rely on BadgerCare.

Wisconsin is the first state to get federal approval to charge mandatory monthly premiums for people with incomes below the federal poverty level. Premium requirements will apply to people with incomes as low as $500 per month. The state will start charging $8 per month to childless adults, and if they can’t pay, they will be kicked off of Medicaid for six months before they can re-enroll. Some will be able to get that amount lowered by completing a voluntary health risk assessment and engaging in so-called “healthy behaviors.”

Charging premiums is likely to have broad negative consequences for thousands of Wisconsinites. Many people with incomes below the federal poverty level do not have access to credit cards or bank accounts, and even relatively small premiums can lead to substantial challenges for people whose incomes often can’t cover all their basic needs, like housing, transportation, and food.

Various studies have found that premium increases cause many low-wage people to lose their insurance coverage. Those adults will often have to rely on emergency rooms as their fallback source of health care. Further, trying to collect small monthly premiums will be a tedious and costly headache. According to a statement by the Center on Budget and Policy Priorities, Arkansas cancelled its monthly payment requirement when the state spent over $9 million to collect less than $500,000 in premiums.

Wisconsin is also implementing $8 copays for childless adults on BadgerCare who use the emergency room when a provider determines that it wasn’t an emergency. This policy may lead to confusion and risks for people who delay seeking necessary medical care. However, this and all other copays for those on Medicaid are temporarily suspended until June 30, 2020, while the state complies with federal requirements for tracking the costs for people enrolled in Medicaid.

The state will also require that people answer questions about drug use and their willingness to seek treatment. Responses will not impact their eligibility, but they must respond in order to enroll in or renew BadgerCare coverage. While this is less harmful than the drug-testing originally proposed by the Walker administration, it’s still intrusive and unnecessary. Study after study has shown that people who use public assistance programs, like Medicaid, are no more likely to use drugs than the rest of the population.

The new changes to BadgerCare will not only create hardships for affected individuals and their households, but will indirectly hurt other health care stakeholders. That’s because restricting access to the preventative health services that BadgerCare provides will increase reliance on hospital emergency rooms. Emergency rooms are far more expensive than preventative care, and hospitals will have to provide more uncompensated care. That increased expense will likely be shifted to other patients with insurance.

The state has taken steps to mitigate some harmful impacts of the new policies. For example, they will allow people to remain in BadgeCare for up to one-year before requiring that they pay accrued monthly premiums, and have not barred other organizations from helping to ease financial burden by paying monthly premiums.

Wisconsin joins a growing number of states who are making it harder for people with Medicaid to keep their coverage and stay healthy. In a time when more and more Americans are finding it tougher to pay for their health care, these misguided changes place additional burdens on those furthest from opportunity. This will harm thousands of Wisconsinites who are stuck in cycles of poverty and experiencing health disparities and inequities. These new BadgerCare obstacles will likely increase the number of people who are uninsured and will move our state backwards in terms of health care. 

William Parke-Sutherland