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4.1.

4.2.

for projects which are conducted by or subject to the approval of CMS, and that are designed to study, evaluate, or otherwise examine the Medicaid or CHIP program — including public benefit or service programs, procedures for obtaining Medicaid or CHIP benefits or services, possible changes in or alternatives to Medicaid or CHIP programs and procedures, or possible changes in methods or levels of payment for Medicaid benefits or services. CMS has determined that this demonstration as represented in these approved STCs meets the requirements for exemption from the human subject research provisions of the Common Rule set forth in 45 CFR 46.104(d)(5).

ELIGIBILITY AND ENROLLMENT

State Plan Eligibility Groups Affected by the Demonstration. The state plan populations affected by this demonstration are outlined in Table 1, which summarizes each specific group of individuals and specifies the authority under which they are eligible for coverage and the name of the eligibility and expenditure group under which expenditures are reported to CMS and the budget neutrality expenditure agreement is constructed.

Demonstration Expansion Eligibility Groups. Table 1 summarizes the specific groups of individuals, and specifies the authority under which they are eligible for coverage. Demonstration Populations 1 and 2 in Table 1 is made eligible for the demonstration by virtue of the expenditure authorities expressly granted in this demonstration. Coverage of Demonstration Populations 1 and 2 are subject to Medicaid laws and regulations unless otherwise specified in the “Title XIX Requirements Not Applicable to the Demonstration Population” section of the expenditure authorities document for this demonstration.

Table 1: Eligibility Groups Affected by the Demonstration

Demonstration Eligibility Criteria Funding Expansion Groups Stream Population 1. Childless e Ages 19 through 64 Title XIX Adult Demonstration e Effective monthly income at or below 100 percent of Population the FPL Not pregnant Do not qualify for any other full-benefit Medicaid or CHIP eligibility group Are not receiving Medicare Childless adults may have children, but do not qualify as a parent or caretaker relative (e.g., either the children are not currently living with them or those children living with them are 19 years of age or older)

Wisconsin BadgerCare Reform Approval Period: October 29, 2024 through December 31, 2029 Page 9