Wisconsin Medicaid proposal includes drug tests, premiums

Wisconsin on Monday unveiled plans to overhaul Medicaid by requiring members to pay insurance premiums and undergo a drug screening to participate in the program.

The state's Department of Health Services said it will submit a waiver request to the CMS on May 26, following public comment.

The proposal looks a lot like the one used in Indiana's Medicaid expansion known as Healthy Indiana 2.0, which is facing renewed scrutiny following reports that the state used misleading and inaccurate information to justify an extension.

Under Wisconsin's proposal, childless adults would have to pay monthly premiums ranging from $1 to $10 per household based on income. Those with household incomes up to 20% of the federal poverty level would be exempt from paying a premium.

Members would receive premium breaks if they "engage in healthy behaviors," though the requirements for healthy behavior incentives weren't outlined. Members would also be required to take a health risk assessment to access those premium discounts.

Medicaid members who visit the emergency room would be required to make an $8 copay for the first visit and a $25 copay for subsequent visits over a yearlong period. The requirement is meant to encourage members to use healthcare services appropriately, the state's Department of Health Services said.

The proposal would also limit Medicaid eligibility to 48 months, unless the member is employed or in a training program. After 48 months, members will not be eligible for benefits for six months. Limit eligibility will not include time in which the member is working for at least 80 hours a month. Individuals with mental illness or disabilities, full-time students and those older than 49 would be exempt from the work requirement and time limits.

Wisconsin is also seeking permission to require members to undergo a drug screening or test to be eligible for benefits. If given the greenlight, Wisconsin would be the first state to drug test Medicaid beneficiaries.

Members who test positive for drug use would be referred to a substance abuse disorder treatment program. Members who refuse to take the test would be ineligible for benefits for six months.

Wisconsin Republican Gov. Scott Walker, who has refused to expand Medicaid under the Affordable Care Act, sent a public letter to President Donald Trump in December asking for permission to drug test applicants for the Supplemental Nutrition Assistance Program.

Walker's past attempts to drug test SNAP applicants have failed. In 2015, Walker's administration sued to force the Obama administration to approve drug testing for SNAP but the court tossed the lawsuit.

Finally, Wisconsin is requesting a waiver of the federal exclusion for reimbursement of residential substance abuse treatment. It is also asking the CMS to waive the 15-day residential treatment limit for coverage found in Medicaid managed care regulations.

Medicaid has never paid institutions of mental disease (IMDs) for beneficiaries 21 and over. However, a mega managed-care rule finalized last year allowed states to reimburse managed-care plans if patients with behavioral issues stayed in an IMD for no more than 15 days.

Several state Medicaid agencies have pushed for the CMS to extend the length of stay for inpatient psychiatric services, saying some patients with substance abuse disorders or severe depression need more time to get well.

Almost 797,000 people are enrolled in Wisconsin's Medicaid program. Of those, 147,000 are childless adults who would be affected by these proposals.