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Wisconsin BadgerCare Reform Approval Period: October 29, 2024 through December 31, 2029 Page 1 CENTERS FOR MEDICARE & MEDICAID SERVICES EXPENDITURE AUTHORITY

NUMBER: 11-W-00293/5

TITLE: Wisconsin BadgerCare Reform Section 1115 Demonstration

AWARDEE: Wisconsin Department of Health Services

Under the authority of section 1115(a)(2) of the Social Security Act (“the Act”), expenditures made by Wisconsin for the items identified below, which are not otherwise included as expenditures under section 1903 of the Act shall, for the period from October 29, 2024 through December 31, 2029, unless otherwise specified, be regarded as expenditures under the state’s title XIX plan.

The following expenditure authorities may only be implemented consistent with the approved Special Terms and Conditions (STC) and shall enable Wisconsin to operate the above-identified section 1115(a) demonstration. 1. Childless Adults Demonstration Population. Expenditures for health care-related costs for eligible non-pregnant, uninsured adults ages 19 through 64 years who have family incomes up to 95 percent of the federal poverty level (FPL) (effectively 100 percent of the FPL including the five percent disregard), who are not otherwise eligible under the Medicaid State plan, other than for family planning services or for the treatment of Tuberculosis, and who are not otherwise eligible for Medicare, Medical Assistance, or the State Children’s Health Insurance Program (CHIP).

2. Former Foster Care Youth from Another State. Expenditures to extend eligibility for full Medicaid state plan benefits to former foster care youth are under age 26, who turned 18 on or before December 31, 2022, who were in foster care under the responsibility of another state or tribe on the date of attaining 18 years of age (or such higher age as the state has elected for termination of Federal foster care assistance under title IV-E of the Act), were enrolled in Medicaid on the date of aging out of foster care, and are now applying for Medicaid in Wisconsin.

3. Residential and Inpatient Treatment Services for Individuals with Substance Use Disorder. Expenditures for Medicaid state plan services furnished to otherwise eligible individuals who are primarily receiving treatment and/or withdrawal management services for substance use disorder (SUD) who are short-term residents in facilities that meet the definition of an institution for mental diseases (IMD). All requirements of the Medicaid program expressed in law, regulation, and policy statement, not expressly identified as not applicable in the list below, shall apply to the Childless Adults Demonstration Population.