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Page 2 – Ms. Lisa Olson

section 1115 demonstration amendment approval, Wisconsin has authority to provide coverage for Advisory Committee on Immunization Practices (ACIP)-recommended vaccinations for persons aged 65 and over, including COVID-19 vaccinations, to the extent necessary, for all persons enrolled in the demonstration.

The population eligible for the SeniorCare demonstration consists of Wisconsin residents, age 65 and older, with income at or below 200 percent of the Federal Poverty Level (FPL). To be eligible to enroll in SeniorCare, otherwise eligible individuals must not be eligible under the Medicaid state plan, with a few limited exceptions for certain limited-benefit Medicaid state plan eligibility groups. First, otherwise eligible individuals may enroll in SeniorCare even if they are also eligible for enrollment in one of the limited-benefit Medicaid state plan eligibility groups that receives medical assistance only for payment of Medicare premiums and/or cost-sharing (in other words, are eligible for enrollment in a Medicare Savings Program as Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries, Qualifying Individuals, or Qualified Disabled Working Individuals). Thus, some persons who are eligible for coverage under the Wisconsin SeniorCare demonstration are also eligible for enrollment in coverage consisting only of payment of Medicare premiums under the limited-benefit Medicaid state plan groups described in sections 1902(a)(10)(E) and 1933 of the Act. Second, otherwise eligible individuals may enroll in SeniorCare even if they are also eligible for enrollment in the limited- benefit state plan eligibility group that receives medical assistance only for tuberculosis-related benefits, as described in sections 1902(a)(10)(A)(ii)(XII) and 1902(z)(1) of the Act. Third, otherwise eligible individuals may enroll in SeniorCare even if they are also eligible for enrollment in the limited-benefit state plan eligibility group that receives medical assistance only for family planning benefits, as described in sections 1902(a)(10)(A)(ii)(XXI) and 1902(ii) of the Act. Individuals with commercial health insurance may also enroll in the SeniorCare demonstration if all other eligibility criteria are met.

Starting March 11, 2021, section 1905(a)(4)(E) of the Act (as added by section 9811 of the American Rescue Plan Act of 2021 (ARP)), and corresponding amendments to sections 1902(a)(10), 1916, 1916A, and 1937 of the Act, require states to cover COVID-19 vaccines and their administration, without cost-sharing, for nearly all Medicaid beneficiaries, including most groups receiving limited-benefit packages under the state plan or a section 1115 demonstration. This coverage is required beginning March 11, 2021, and (generally) ending on the last day of the first calendar quarter that begins one year after the last day of the COVID-19 emergency period described in section 1135(g)(1)(B) of the Act. The ARP amendments require states to cover COVID-19 vaccines and their administration under the Medicaid state plan for members of the eligibility groups who otherwise receive medical assistance under the state plan only for tuberculosis-related or family-planning benefits; therefore, some persons enrolled in the SeniorCare demonstration began receiving COVID-19 vaccination coverage under the state plan on March 11, 2021. However, the ARP amendments do not permit or require states to provide this COVID-19 vaccination coverage to persons who are eligible for medical assistance consisting only of payment of Medicare premiums pursuant to sections 1902(a)(10)(E) or 1933 of the Act.

This demonstration amendment provides expenditure authority, to the extent necessary, for COVID-19 vaccine administration coverage for the entire limited-benefit population enrolled in