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

2.0 Milestone Completion Over the course of the demonstration, Wisconsin Medicaid will work with internal and external stakeholders to develop, implement, and monitor SUD treatment initiatives designed to achieve the following milestones: 2.1 Access to Critical Levels of Care for OUD and Other SUDs

Wisconsin Medicaid will establish new coverage policies and enhance existing benefits to provide members access to the full continuum of care for SUD treatment. Currently, Wisconsin Medicaid’s largest coverage gap is for the residential level of care. Under this demonstration, Wisconsin will develop coverage policies for residential facilities, including IMD facilities that are not otherwise eligible for matched expenditures under Section 1903 of the Social Security Act. Following implementation of the new residential benefit by February 2020, Wisconsin Medicaid will reassess coverage for each level of care to identify any additional gaps or barriers to treatment. Initiatives to remove treatment barriers will be prioritized so that Wisconsin Medicaid members can access SUD treatment at the appropriate level of care. The following table provides an overview of each critical level of care with current Wisconsin Medicaid coverage along with proposed changes.

Level of Care Current State Future State Summary of Actions Needed Outpatient Services This is an existing service under the State Plan. Continue to monitor and evaluate services and expenditures. No immediate action. Will review coverage policies following implementation of residential benefit and update to State regulations. Intensive Outpatient Services This is an existing service under the State Plan. Continue to monitor and evaluate services and expenditures. No immediate action. Will review coverage policies following implementation of residential benefit and update to State regulations. Medication Assisted Treatment This is an existing service under the State Plan. Continue to monitor and evaluate services and expenditures. No immediate action. Will review coverage policies following implementation of residential benefit and update to State regulations.