Gov. Scott Walker (copy)

Some Medicaid enrollees in Wisconsin would be subject to drug testing, premiums, coverage limits and other rules under a proposal Gov. Scott Walker plans to submit to the federal government for approval.

Lynn Grooms/Agri-View

Childless adults who sign up for Wisconsin’s Medicaid program would be screened for drug use and required to pay premiums under a proposal Gov. Scott Walker’s administration plans to submit next month to the federal government.

The state Department of Health Services released a summary of the proposal Monday. The department will issue a detailed plan Wednesday and gather public comment before submitting it May 26 to President Donald Trump’s administration for approval.

Wisconsin would be the first state with mandatory drug screening for Medicaid enrollees, said Robin Rudowitz, a Medicaid expert with the Kaiser Family Foundation. Walker has also announced plans to drug test able-bodied adults seeking food stamps and unemployment payments.

Public hearings on the Medicaid proposal will take place in Wausau on April 26 and Milwaukee on May 1.

Under the proposal, adults without dependent children who seek BadgerCare, the state’s main Medicaid program, would have to submit to drug testing if screening called for it. Those who refuse testing would go six months without coverage. Those who test positive could enroll in BadgerCare and would be referred to treatment.

Enrollees with annual individual incomes of $2,412 to $12,060, the cutoff for BadgerCare, would have to pay monthly premiums of $1 to $10. For those who engage in healthy behaviors, the amount would be halved.

In other proposed changes, childless adults would face higher premiums if they didn’t complete a health risk assessment.

They would have to pay $8 for an emergency room visit and $25 for a second visit the same year.

Coverage for able-bodied adults younger than 50 would be limited to four years unless they work or are in job training.

Some of the changes are similar to rules in Indiana’s Medicaid program. Vice President Mike Pence, Indiana’s former governor, changed that state’s program along with consultant Seema Verma, who now oversees Medicaid and Medicare for the Trump administration.

“It is designed for moving folks from dependence to independence,” Michael Heifetz, Wisconsin’s Medicaid director, said in discussing the proposals earlier this year.

The work and job training requirement would affect about 49,000 people, and the job training and administration would cost about $48 million a year when fully implemented, said John Dyck, a Medicaid analyst for the Wisconsin Legislative Fiscal Bureau.

No cost estimate for the drug testing was available, he said.

Health care advocates say the changes would make coverage more difficult for those who need it.

Dr. Richard Brown, a substance use expert at the UW School of Medicine and Public Health, said many drug users can quit for a few days before testing or find ways to avoid detection.

“If the purpose of this policy is to sustainably discourage drug use, then the policy is doomed to fail,” Brown said.

“Most drug users would still end up on Medicaid,” he said.

Voluntary drug screening in health care settings works better than mandatory screening and testing by the government, Brown said. Drug testing can result in false positives, and the state could face lawsuits if it doesn’t do the testing properly, he said.

Robert Kraig, executive director of Citizen Action of Wisconsin, said the drug screening and testing plays into stereotypes about people on BadgerCare.

“It may be very good politics for a governor’s race, but that’s mostly what it is,” Kraig said.

Jon Peacock, research director of the Wisconsin Council on Children and Families, said many people who sign up for BadgerCare don’t have checking accounts or credit cards.

“Even small increases in premiums cause many low-income people to lose their insurance coverage,” Peacock said. “It will also result in a less healthy workforce and a significant increase in the cost of uncompensated care for hospitals.”

The changes were approved by the Legislature in 2015, in the last two-year budget.

Currently, about 147,000 of the 977,000 people on BadgerCare are childless adults.

Nearly 1.2 million state residents get some form of Medicaid.

Wisconsin is one of 19 states that refused the Affordable Care Act’s Medicaid expansion, which provides federal funding for at least 90 percent of the cost for new enrollees who make up to 133 percent of the federal poverty level.

Walker and the Legislature opted instead to cover all adults under the poverty level, allowing about 130,000 childless adults to sign up but shifting roughly 63,000 parents off Medicaid.

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