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Wisconsin BadgerCare Reform Approval Period: October 29, 2024 through December 31, 2029 Page 4 Attachment E. Evaluation Design (Reserved) Attachment F. Monitoring Protocol (Reserved)

2. PROGRAM DESCRIPTION AND OBJECTIVES

With the implementation of the Affordable Care Act provisions that provided federally-funded subsidies to help individuals and families purchase private health insurance, Wisconsin saw the BadgerCare Reform demonstration as an opportunity to reduce the uninsured rate and encourage beneficiaries to access coverage in the private market.

The Wisconsin BadgerCare Reform demonstration provides state plan benefits, other than family planning services and tuberculosis-related services, to childless adults who have effective family incomes up to 100 percent of the Federal Poverty Level (FPL) (effective income is defined to include the five (5) percent disregard). Coverage for this population focuses on improving health outcomes, reducing unnecessary services, and improving the cost- effectiveness of Medicaid services.

In accordance with CMS’ November 21, 2016, CMCS Informational Bulletin (CIB), Section 1115 Demonstration Opportunity to Allow Medicaid Coverage to Former Foster Care Youth Who Have Moved to a Different State, the BadgerCare Reform demonstration was amended in December 2017 to add coverage of former foster care youth defined as individuals under age 26 who were in foster care in another state or tribe of such other state when they turned 18 (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 at that time or at some point while in such foster care, and are now applying for Medicaid in Wisconsin. With the addition of this population, Wisconsin has a new demonstration goal to increase and strengthen overall coverage of former foster care youth and improve health outcomes for this population.

On October 29, 2024, CMS approved a five-year extension of the demonstration to allow the state to continue the existing demonstration authorities, which provide authority for the expansion of eligibility to childless adults, former foster care youth, services for substance use disorders in an institution for mental disease, and the $8 copay for non-emergency use of the emergency department. The extension does not include any changes to the approved demonstration authorities.

During the demonstration period, the state seeks to achieve the following goals:

SUD Goals: 1 Increase rates of identification, initiation, and engagement in treatment for SUD 2 Increase adherence to and retention in treatment 3 Reduce overdose deaths, particularly those due to opioids 4 Reduce utilization of emergency departments and inpatient hospital settings for treatment where the utilization is preventable or medically inappropriate through improved access to other continuum of care services 5 Fewer readmissions to the same or higher level of care where the readmission is preventable or medically inappropriate