Two weeks ago, Gov. Scott Walker announced he would turn down the Medicaid expansion, opting for another plan he said would cover fewer people. Lawmakers will review his plan, which was part of the budget released last week, for the next few months. Meanwhile, Democrats and advocacy groups are pushing for two other plans during that time. Below is a rundown of all three plans.
What is the Medicaid expansion?
It is an option states have to expand eligibility in their Medicaid programs to those under 133 percent of the poverty level. The poverty level is currently an individual making $11,490 a year. Someone at 133 percent of the poverty level makes $15,282, and someone at 200 percent makes $22,980.
How much does the federal government pay for the expansion?
The federal government pays 100 percent of the expansion’s costs until 2016. Then, the ratio gradually declines to its permanent level of 90 percent in 2020.
Walker said given federal debt problems, he is unsure whether the federal government could maintain those funding promises. Walker’s opponents point to a provision Arizona Gov. Jan Brewer put in her acceptance of the expansion that let Arizona opt out if the ratio changes.
How does that compare to the current ratio?
The federal government currently pays about 60 percent for the state’s Medicaid programs, and the state pays about 40 percent. Walker’s plan would maintain that ratio.
Does Wisconsin already cover all those less than 200 percent of the poverty level?
Not all of them. Wisconsin is one of the few states that sets their eligibility at the 200 percent and under mark, but because of an enrollment cap, it effectively leads to a long wait list.
The BadgerCare Plus program, which is for low-income children and their families, covers the most. The BadgerCare Plus Core program for childless adults does not. For the latter program, a 2009 cap on enrollees has led to the current 20,000 enrollees and a wait list of more than 100,000 childless adults.
What would Walker’s plan do?
Walker would remove the BC+C cap, giving Medicaid to 82,000 childless adults under 100 percent of the poverty level, and putting those above that level in private exchanges. He would also reduce the eligibility rate for the BC+ program to 100 percent, moving 87,000 of the less poor parents to private insurance exchanges and keeping the poorest in Medicaid. The state would have 5,000 fewer Medicaid enrollees, although his plan would not impact children.
Walker said his plan is meant to help the poorest while encouraging independence among those who are better off. He said his plan would insure 224,850 more people.
What do the Democrats want to do?
Democrats and other groups want to keep parents under 200 percent of the poverty level in Medicaid. They also want to use federal expansion funds to give Medicaid to childless adults under 133 percent of the poverty level, many of whom are on the wait list.
Medicaid enrollment would grow by about 175,000, according to the Legislative Fiscal Bureau. It would reduce the uninsured by 252,678, according to Walker’s numbers.
Are there any other options?
There is a third option that some groups are pushing, which would add about 116,800 people to Medicaid, according to the LFB.
It would reduce BC+ eligibility, although it sets the number at 133 percent of the poverty level, not the 100 percent Walker proposes. But like Democrats want, it would use federal expansion funds to expand Medicaid to childless adults under 133 percent of the poverty level.
How much would the state have to pay for Medicaid under each plan?
The LFB released its preliminary projections of the plans earlier this month. Their projections are slightly different from Walker’s numbers.
Under Walker’s plan, the state would pay $320.3 million more by 2020, and the federal government would pay $460.6 million.
The Democrats’ plan would cost the state $66.7 million more by 2020 and would cost the federal government $4.38 billion.
The third plan does not increase state Medicaid expenses. Rather, it saves the state $164.2 million by 2020 while costing the federal government $4.1 billion.
What are Walker’s arguments for the plan?
Walker said he wants to cut the number of uninsured by about half, a number not too far off from the Democratic proposal. By reducing the eligibility to those under the poverty level, Walker said he wants to make sure the government helps those who are truly poor. He said his plan would also encourage independence from government to those above the poverty level.
What are criticisms of Walker’s plan?
Opponents have said Walker’s plan covers less people while costing more to the state. They have also said the exchanges were not built for low-income people and would be less affordable, despite some federal subsidies. That would lead to more uninsured people, opponents say.
