Originally
DHS says technology will help identify who meets the rule or qualifies for an exemption. But some cases may still require a “very human kind of workflow.”
The Medicaid work requirement does not apply to everyone on BadgerCare Plus
People may qualify for exemptions, including pregnancy, disability, Medicare enrollment, meeting Wisconsin Works work requirements, having a child in the household under the applicable age threshold or qualifying for a short-term hardship exemption
But several exemption questions remain unsettled
Homelessness
Homelessness is not listed as an exemption in the federal law, and DHS says states may not add exemptions beyond those allowed by federal law
That does not mean homelessness is irrelevant
Medicaid Director Amanda Dreyer said during a July 30 media call that homelessness can make it harder for people to meet or prove compliance with a work, school, volunteer or exemption requirement
“It’s a whole combination of difficult experiences for an individual who is unhoused or unsheltered to be able to meet a work requirement or an education requirement or volunteer requirement,” Dreyer said
She added: “In some cases, that’s going to mean a very human kind of workflow. Technology certainly helps us in a lot of ways, but we’re going to need to lean in and hold hands with our partners around the state to take care of people who are unhoused and help them get food and healthcare in an entirely new and difficult way.”
DHS Secretary Kirsten Johnson said DHS is working with community partners and organizations that support people who are unhoused or experiencing homelessness
The question, Johnson said, is “how do we help people navigate the system who may have the least number of re
Medical frailty
Medical frailty remains another unresolved area
Johnson said DHS is still working through the medical-frailty and impairment definitions and waiting for additional guidance from the Centers for Medicare and Medicaid Services
“What we’re really looking toward for the first year is existing either their diagnosis codes or things that we can identify that clearly indicate that an individual would fall into that medically frail category,” Johnson said
Dreyer said the human conversation may matter most
“The conversation with a human being about their situation is going to be the most impactful part of the medical frailty determinations,” Dreyer said
Why it matters locally
In Racine County, some people may be easy for the state to verify through existing data
Others may have irregular work, seasonal work, self-employment, unpaid work, unstable housing, disability-related barriers or medical conditions that are harder to document through an automatic data match
Those cases are where the policy becomes local: proof, notices, phone calls, document uploads and eligibility-worker review
More Medicaid coverage
- As Wisconsin’s Medicaid work rule nears, can Racine County process the proof? — the main story on Racine County’s workload, call-center capacity and proof-processing questions.
- What BadgerCare members can do now — a practical checklist for members before notices, renewals and proof requests begin.
- Why FoodShare funding and Medicaid work rules are colliding — why new FoodShare quality-control funding is not the same as dedicated Medicaid work-rule funding.
- How we know: Medicaid work-rule reporting notes — source notes, data points and unanswered questions behind this reporting.
- Racine County Medicaid work requirement: 7,441 BadgerCare members may be affected — earlier background on who may be affected, when notices were expected and why paperwork risk matters.
