Gov. Scott Walker

Gov. Scott Walker, shown last month discussing the creation of a new public policy leadership and research center at UW-Madison, on Wednesday submitted his plan to drug screen childless adults who seek Medicaid to President Donald Trump's administration.

Scott Bauer/Associated Press

Gov. Scott Walker on Wednesday asked President Donald Trump’s administration to let Wisconsin become the first state to require drug screening for poor, childless adults who seek Medicaid and impose a time limit on coverage unless they work.

Walker’s administration softened its initial plan in response to public comments, however, reducing premiums and emergency room co-payments and letting people skip drug tests and sign up for Medicaid when they’re ready to start drug treatment.

The proposal “is about helping people transition from public assistance into Wisconsin’s workforce, where they can build a solid financial foundation for themselves and their families,” Walker said in a statement.

People with disabilities are exempt from the work requirement.

Jon Peacock, research director for the Wisconsin Council on Children and Families, said the changes made to the proposal “make modest improvements, but they don’t alter the fact that the waiver would create bureaucratic barriers that increase administrative costs and keep people out of BadgerCare.”

He said “the state’s goal of increasing the size and health of the Wisconsin workforce would be accomplished much more effectively by significantly increasing the state’s investment in drug treatment programs.”

The plan includes a new residential drug treatment benefit for up to 90 days for all Medicaid members.

Arkansas, Arizona, Indiana, Maine and other states have received or are seeking permission to implement some of the same changes to their Medicaid programs. But Wisconsin could become the first to require drug screening and enact a four-year limit on coverage for childless adults with incomes below the poverty level unless they work or train for a job, according to the Kaiser Family Foundation.

The Trump administration has indicated a willingness to approve such changes, some of which were approved by the state Legislature two years ago but not pursued during President Barack Obama’s presidency.

If the changes are approved, they would begin in about a year, though some observers have said the moves could end up in court. Efforts by Florida and Michigan to broadly drug screen welfare recipients — Walker has also announced plans to drug test able-bodied adults seeking food stamps and unemployment payments — have been found unconstitutional, the Washington Post reported.

Nearly 146,000 of the 792,000 people on BadgerCare, Wisconsin’s main Medicaid program, are adults without dependent children, who must make $12,060 a year or less to qualify. Nearly 1.2 million residents are on some form of Medicaid.

Under Walker’s plan, childless adults will face premiums and ER co-pays. But there will be no premium for people making up to $6,030 a year, and the premium will be $8 a month for those making more. Originally, premiums would have ranged from $1 to $10 a month, beginning with people making $2,412 a year.

The state Department of Health Services said it will consider a grace period of 12 months for people who fail to pay premiums, instead of cutting them off coverage immediately.

ER co-pays will be $8 per visit, instead of $8 for the first visit and $25 for subsequent visits within a year, as proposed initially.

Enrollees must submit to a drug test if drug screening calls for it. If they test positive, they can enroll in coverage if they pursue treatment.

Under modifications to the plan, people can skip the drug test if they’re willing to enter drug treatment. If they refuse treatment, they can reapply anytime they consent to treatment — not only after six months, as in the initial plan.

In addition to work and job training, community service and seeking work will be considered as exceptions to the four-year limit on coverage, the health department said.

Walker said that with the Medicaid plan, “we’re continuing to build on Wisconsin’s legacy as a leader in welfare reform.”

But Mike Bare, research director for Community Advocates’ Public Policy Institute in Milwaukee, said “Wisconsin’s outlier health coverage system already has large affordability and coverage gaps, and this waiver will create even more.”

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David Wahlberg is the health and medicine reporter for the Wisconsin State Journal.