Wisconsin’s Medicaid director says new work requirements in the federal budget bill House Republicans passed last month could extend beyond those who use the Medicaid or FoodShare programs. 

In Wisconsin, almost 1.3 million children and adults are enrolled in Medicaid, and more than 700,000 receive FoodShare. The new legislation expands work requirements for both programs.

As it relates to Medicaid, the new rules would affect about 194,000 Wisconsin adults between the ages of 19 and 64 who do not have dependent children at home and have an income at or below 100 percent the federal poverty level. 

“The bill creates new work requirements for this population,” Wisconsin Medicaid Director Bill Hanna told WPR’s “Wisconsin Today.” “We estimate that about 63,000 of those currently enrolled are not meeting those requirements today.”

Under those requirements, individuals would need to meet 80 hours of qualifying activities — like working, volunteering or education — per month. The bill would also require individuals to renew their eligibility with documentation every six months, versus the current 12-month requirement. 

Work requirements already exist for adults aged 19 to 54 without dependent children under Wisconsin’s Supplemental Nutrition Assistance Program, called FoodShare. But those would expand under the bill to include people up to age 65 and adults who have children over the age of 6.

“We anticipate that an additional 88,000 people in Wisconsin will now need to submit additional paperwork to the state in order to prove that they are meeting those work requirements,” Hanna said.

Hanna told “Wisconsin Today” about the potential effects of the bill on Medicaid and FoodShare in Wisconsin.

This interview has been edited for length and clarity.

Rob Ferrett: Could this legislation potentially cause people to be kicked off of Medicaid who shouldn’t be?

Bill Hanna: Yeah, I think there’s a lot of unintended consequences. … Between the ages of 19 and 54, approximately 70 percent of those folks are working, when you look at national data. It’s when you get into that older range, between 55 and 64, that that number goes down. I think what you’ll see is a bigger impact on that older population, primarily women. 

I think the other point is this will certainly increase the uninsured rate in Wisconsin. And what we know is that individuals, if they lose their Medicaid, it doesn’t mean they don’t need health care. It just means they don’t have a way to pay for it now, which will increase uncompensated care for hospitals, doctors and other health care providers. 

Income is important to hospitals, especially as we’ve seen closures in western Wisconsin, and uncompensated care really impacts all of us. We’re all health care consumers, and when hospitals don’t have enough revenue to stay open, they have to pass those costs on to other health care consumers. So while this may appear to just be impacting those 63,000 individuals that we’re talking about, this really has an impact across the whole health care economy.

RF: When I talked to Wisconsin Sen. Ron Johnson, he said states have expanded Medicaid to cover those it’s not meant for — that they’re abusing the system. What do you think of that? 

BH: States are certainly not gaming the system. Everything that states are doing is currently allowable under federal law, and in Wisconsin, we’re really in a different boat than much of the country. Wisconsin has done its own partial expansion, so we’re not getting the 90-10 match like many states are. For our expansion population, the state is putting up 40 percent of that cost. We are also incredibly judicious with how we use provider taxes, always with an end goal of making sure hospitals stay open and stay viable and continue to serve Medicaid individuals. 

On qualified individuals or ineligible folks: That’s just not true. Wisconsin and all states go through a review by the federal government every three years determining whether states are making errors or allowing folks on the program that shouldn’t be on the program. Wisconsin’s most recent review was in 2022, and we had a 99.5 percent accuracy rate. And when you talk about what’s inaccurate, it’s really about dotting i’s and crossing t’s, not that folks are ineligible. So the facts aren’t there. We run a really good program in Wisconsin, and these cuts will hurt not only the individuals that we talked about, but again, our health care economy. 

RF: What does this mean for the workload at the state with that additional documentation, both for SNAP and for Medicaid? 

BH: It’s additional workload. The bill also shifts other costs from the federal government to states. Today, FoodShare is matched 50-50 in terms of how we administer the program. The bill changes that to where the states now need to pay 75 percent of the cost to run the FoodShare program. Also, right now, the SNAP benefits that go out to individuals are paid 100 percent by the federal government. The bill adds, for the first time, a matching requirement for states at least 5 percent, which is $69 million per year in Wisconsin. And it goes up to as high as 25 percent depending on a state’s error rate. 

So between the workload and system changes we have to make in order to collect all the documentation, the cost shifting and administrative costs and the new matching requirement for FoodShare benefits, we estimate it’ll cost Wisconsin about $119 million [extra] in the first year alone, just to maintain the program that we have today.