PUBLIC NOTICE
Department of Health Services
Medicaid Purchase Plan Premium Changes
The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (the Department), is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and s. 49.471 of the Wisconsin Statutes. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is in effect. The following changes to the Medicaid State Plan are being requested to implement s. 49.472(4) of the Wisconsin Statutes. Change in Medicaid Purchase Plan (MAPP) Premiums
The Department is requesting that premiums be required of MAPP recipients in the following manner:
Individuals eligible for MAPP whose individual gross income exceeds 100% of the federal poverty level will be subject to the following premium policies.
Monthly Premium Calculation
1. Any verified impairment-related work expenses and monthly out-of-pocket medical or remedial expenses will be subtracted from an individual’s gross income.
2. If the net amount after subtracting these expenses is at or below 100% of the federal poverty level, the premium amount will be $25.
3. If the net amount is above 100% of the federal poverty level, the amount exceeding the federal poverty level will be multiplied by three percent (0.03). That amount will be added to $25 and rounded down to the nearest whole dollar.
Premium Payment Requirements
For applicants, premiums must be paid in advance for initial eligibility to begin. Ongoing benefit months require payments by the 10th day of the benefit month.
Temporary Premium Waivers
Individuals who experience a temporary hardship that makes them unable to pay their premium may apply for a temporary premium waiver.
Non-Payment of Premiums
If an individual does not pay the monthly premium in the benefit month, a restrictive reenrollment period (RRP) of three calendar months will be applied, unless there is good cause.
Individuals will be able to regain eligibility during the RRP if any of the following conditions are met:
- The individual pays all past-due premiums by the last day of the RRP.
- The individual’s income drops below 100% of the federal poverty level.
- The individual is granted a temporary premium waiver.
The changes will be effective January 1, 2024, for new applicants and for existing members who no longer have continuous Medicaid coverage as a result of the public health emergency. For existing members who still have continuous coverage, the changes will be effective as of the member’s next renewal after January 1, 2024.
The change to Medicaid, is projected to result in decreased annual expenditures of $6,436,000 all funds (AF), composed of $3,904,000 federal match (FED) and $2,532,000 state funds/general purpose revenue (GPR).
Copies of Changes
Copies of the Medicaid state plan amendment may be obtained free of charge by calling or writing:
Mail:
ATTN: DHS SPA Coordinator
Bureau of Benefits Policy
Division of Medicaid Services
P.O. Box 309
Madison, WI 53701-0309
Fax: (608) 266-1096
Attention: DHS SPA Coordinator
Copies of the state plan change will be made available for review at the main office of any county department of social services or human services.
Written Comments
