I have often said that the best action that CMS can take to support state innovation is to get out of the way. We’ve heard loud and clear that states want room to explore new ways of delivering care and designing programs to help their Medicaid beneficiaries live healthier, more independent lives. We’ve answered that call by offering states unprecedented flexibility to design healthcare reforms through the use of section 1115 Medicaid demonstrations, and we continue to deliver on that promise.
Today, I signed and delivered our approval (PDF, 1.03 MB) of Wisconsin’s request to amend and extend the BadgerCare Medicaid reform demonstration for the next five years. This means that this important program will continue to provide health coverage to more than 178,000 childless adults with incomes below the poverty level, while allowing the state to make a number of locally designed enhancements to strengthen the program.
One change will be the implementation of an innovative new Health Risk Assessment (HRA) program to help the state better identify and support high risk beneficiaries. Adults covered under this demonstration will be required to complete a health risk assessment at the time they apply for Medicaid. This will allow the state to collect important information that can be used to help individuals identify their own health risks, reward beneficiaries for proactively avoiding certain health risks, and equip health plans with information to better address health needs in a more timely and complete manner. Wisconsin will also become the 17th state to receive approval to use federal Medicaid funding to finance a more complete continuum of care for individuals combating substance use disorders, a critical step to help address the ongoing national opioid crisis.
Wisconsin also now becomes the fourth state with current approval to operate a community engagement program to help incentivize working-age adult beneficiaries to participate in activities like job training and employment—joining Indiana, Arkansas, and New Hampshire. I recognize that there are people who disagree with this approach. Some believe that our sole purpose is to finance public benefits, even if that means lost opportunity and a life tethered to government dependence. Instead, what’s needed are local solutions crafted by policy makers who are closer to the people they serve and the unique challenges their communities face.
We will not retreat from this position. In Wisconsin, where the unemployment rate has rested just at or below 3% through this entire year, state leaders recognize that employers are struggling to find talent. In one example, an auto parts manufacturer in Sheboygan has even dropped their high school diploma requirement and has begun hiring individuals without manufacturing experience. What this means is that there are real, life-changing opportunities available to help lift individuals out of the shadows of opportunity and into its light. States rightly want to explore innovative ways to achieve that objective.
Community engagement requirements in Medicaid are not a blunt instrument. We’ve worked carefully to design important protections to ensure that participating states exempt individuals who may not be capable of meeting the requirements. This includes individuals who have disabilities, are medically frail, serve as primary caregivers, or have a medical condition that prevents them from successfully meeting the requirement. We are monitoring the impacts of different state approaches to this policy, and we have set high expectations for an independent evaluation to determine if the demonstration is delivering the results for which it was designed. We won’t rush to rash conclusions based on early findings, but will use those to discern best practices and inform our evaluative work.
And every state who is pursuing this flexibility is approaching it based on their unique needs. For example, in Wisconsin, community engagement requirements will only apply to non-exempt adults under 50 without children. These working-age adults will be required to participate in at least 80 hours per calendar month – that’s 20 hours per week- of qualifying activities like employment, job training, volunteer community service, or enrollment in a qualified work program. Additionally, Wisconsin beneficiaries will have 48 aggregate months – a total of four years - to come into compliance with the requirement before they will be subject to a six-month period of non-eligibility, after which they will be free to re-enroll and start a new 48-month clock.
This is a thoughtful and reasonable policy, and one that is rooted in compassion. That’s because true compassion is giving people the tools necessary to achieve self-sufficiency and to experience the dignity of a job, of contributing to their own care, and gaining a foothold on the path to independence. It is not compassionate to lower our expectations such that we are content to leave Americans with inherent worth on the sidelines of life.
Finally, I want to thank Governor Walker for his leadership, and the entire Wisconsin Medicaid team for their hard work. My favorite days as CMS Administrator are the ones in which I get to celebrate the hard work of our state partners – who are truly living up to their role as the laboratories of democracy and innovation.