Wisconsin Medicaid

WI has not implemented ACA Medicaid expansion, but BadgerCare Medicaid covers everyone under the poverty level

Where in your state to call or visit for Medicaid.How to apply

Online at access.wisconsin.gov or healthcare.gov; or by phone, in person or with a paper application at local Income Maintenance Agencies.

Who is eligible in your state to get Medicaid?Who is eligible

The aged, blind, and disabled.  Also, children and pregnant women with incomes up to 300% of poverty; other adults with incomes up to 100% of poverty.

  • By
  • healthinsurance.org contributor
  • September 27, 2016

No ACA Medicaid expansion, but no coverage gap either

Although Wisconsin has not expanded Medicaid under the guidelines laid out in the ACA, the state’s Badger Care Medicaid program does cover all legally present residents with incomes under the poverty level.  Wisconsin is the only non-Medicaid-expansion state that does not have a coverage gap; all low-income residents either have access to Medicaid or subsidies to help them purchase private coverage in the exchange.

An expensive choice

By not accepting federal funding to expand Medicaid under the ACA, Wisconsin will miss out on $12.8 billion in federal money over the next decade. Instead, federal tax dollars that Wisconsin residents pay will be used to pay for expanded Medicaid in other states; $6.8 billion in Wisconsin federal tax payments will be sent out to other states to fund their Medicaid expansion.

Because Wisconsin has taken a unique approach to partially expanding Medicaid, they are actually paying more in state funds than they would if they were to expand Medicaid as called for in the ACA. Most states that opt for Medicaid expansion will end up with a small increase in their state budget over the next ten years (the federal government pays the full cost of expansion through 2016, but after that, the states pay a very small portion that will never exceed 10 percent of the cost). But in Wisconsin, expanding Medicaid under the ACA would save the state $248 million by 2022.

BadgerCare Plus – past and present

Prior to 2014, BadgerCare Medicaid had much more generous eligibility guidelines than programs in most other states. It was still limited to children, pregnant women, and parents with dependent children, but it covered them with incomes up to 200 percent of poverty level (300% for children and pregnant women).

Medicaid expansion under the ACA would have extended Medicaid coverage to everyone — including adults without dependent children — with incomes up to 138% of poverty. But the Supreme Court ruled in 2012 that states could not be penalized if they didn’t expand their programs, and Wisconsin Governor Scott Walker saw an opportunity to revamp the state’s Medicaid program, providing access to coverage for everyone while relying as much as possible on private coverage.

ACA subsidies to purchase private plans in the exchange are only available to people with incomes between 100 percent and 400 percent of poverty level. So Governor Walker decided to make BadgerCare available to everyone with incomes up to 100 percent of poverty level (pregnant women and children are still eligible with household incomes up to 300% of poverty level). This meant that about 83,000 adults without dependent children became newly eligible for BadgerCare on April 1, 2014.

But in trade, Walker’s plan called for switching to private coverage through the exchange for about 72,000 residents with incomes between 100 percent and 200 percent of poverty level.  This group was comprised almost entirely of parents with dependent children, and they were eligible for BadgerCare Plus under the old rules. Although this group is now eligible for significant subsidies in the exchange, there are concerns among consumer advocates that the people who were previously insured through BadgerCare Plus might not be able to afford private coverage in the exchange (including the out-of-pocket costs for claims), even with subsidies.

For the people who lost eligibility for BadgerCare, the exchange provided a special enrollment period that ran through the end of June 2014. But by September 2014, the state estimated that there were still 28,500 former BadgerCare members who had not enrolled in coverage through the exchange. As a result, a new special enrollment period was enacted, running from September 4 to November 2.

Who is eligible?

BadgerCare Medicaid is available for the following legally-present Wisconsin residents

  • Pregnant women with household income up to 300 percent of poverty.
  • Children 19 and under with household income up to 300 percent of poverty.
  • Adults with household income up to 100 percent of poverty.

How do I enroll?

  • You can enroll online at HealthCare.gov or the BadgerCare website.
  • You can enroll by phone at 1-800-318-2596.
  • You can also enroll in person or by phone at a local Wisconsin Income Maintenance Agency (this map shows the agency for each region – you can click on your region and it will show you the address and phone number of your local office).
  • You can print a paper application and take it to your local Income Maintenance Agency or submit it by mail (the address to use depends on whether you live in Milwaukee County or not).

Enrollment numbers

As of July 2016, there were 1,045,160 people enrolled in Wisconsin’s Medicaid program, which was a 6 percent increase since the end of 2013.

According to Gallup polling data, the uninsured rate in Wisconsin in 2013 was 11.7 percent, and it had fallen to 5.9 percent by the end of 2015. Although the state has not expanded Medicaid under the ACA, the BadgerCare Medicaid program has much more generous eligibility rules than most non-expansion state programs. As such, relatively affordable health insurance is universally available in Wisconsin.

Public support for Medicaid expansion

In the November 2014 election, voters in several counties approved expanding Medicaid, but the vote was symbolic – it was still up to newly-reelected Governor Walker and the state’s legislature, and they have not taken any steps in the ensuing years to change the state’s Medicaid eligibility.