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For over a decade, Wisconsin has heard the same message from Republicans regarding full Medicaid expansion: Accepting 90% federal reimbursement to cover more low-income people will only set Wisconsin up for failure if the federal government abandons its part of the deal. 

At first glance, President Donald Trump’s recently signed big bill appears to validate that argument. The 40 states that have fully expanded are now expected to lose billions of dollars in federal aid while getting tagged with additional administrative costs to create work requirements and eligibility assessments required in the bill. 

But it turns out Wisconsin is still going to be subject to the new federal mandates without the higher federal reimbursement rate that expansion states will continue to receive. In other words, at a time when the Republican-controlled federal government is supposedly pulling out the rug from expansion states, Wisconsin is still left holding the bag.

A look back

Back in 2014, then-Gov. Scott Walker and Wisconsin Republicans made the controversial decision not to accept full Medicaid expansion.

At the time, Walker explained his goal “is to get more people out into the workplace, more people covered when it comes to health care and fewer people dependent on the government, not because we’ve kicked them out, but we’ve empowered them to take control of their own destiny.”

But he also argued that the federal government would eventually pull back on its commitment to fund Medicaid at 90%.

“That commitment is not going to be there and taxpayers all across America will be on the hook,” Walker said. “They are not going to be on the hook in Wisconsin.”

At the time, Wisconsin was one of 25 states not accepting expansion. Now, the state is one of the 10 remaining holdouts, with most of the others in the deep red South. Even reliably red states, like Arkansas and Louisiana, have accepted full expansion. 

Instead of accepting full expansion, Wisconsin chose to cover individuals through BadgerCare, the state’s Medicaid-supported health insurance program for low-income residents set up by former Gov. Tommy Thompson, a Republican. 

Walker and Republicans lowered Medicaid coverage to 100% of the federal poverty line from the previous 200% and eliminated the waiting list for childless adults. Those above the poverty line without employer-sponsored insurance could purchase it through the Affordable Care Act marketplace using federal subsidies, according to the Wisconsin Policy Forum.  

But Wisconsin taxpayers are paying more to cover individuals below the poverty line: 39.3% of costs rather than 10% under full Medicaid expansion. In 2023, Medicaid accounted for 15.7% of state taxpayer spending, according to the policy forum.

Under its approach, Wisconsin doesn’t have an eligibility gap like some states, something Republicans highlight as a reason the state doesn’t need to expand.

But that has come with a loss of federal funds. Over the past decade, Wisconsin’s Department of Health Services estimates, the state has spent about $2.6 billion more to cover the costs of a partial expansion compared with the projected cost under a federal expansion.

Under an expansion, more individuals would be able to access Medicaid. But the Wisconsin Policy Forum found it would have a somewhat modest impact on coverage levels — the percentage change in Medicaid enrollees would be 7.2%, compared with nearly 30% or more in other non-expansion states. 

Work requirements still in effect under Trump bill

With the recent federal bill, Walker and other Republicans still argue Wisconsin was right not to accept federal expansion. The state is going to experience the impacts to a lesser extent than fully expanded states. 

But because Wisconsin receives federal waivers for its Medicaid program, the state is still subject to some provisions under the new law, including the work requirements, eligibility determinations and provider taxes.

Under the new work requirements, individuals covered by Medicaid are required to prove they are working 80 hours per month — parents with dependent children or people who are medically frail are exempted.

As a result, some 230,000 Wisconsin residents could lose coverage while the state incurs administrative costs to account for the new requirements, according to an estimate from U.S. Senate Democrats based on data from the Congressional Budget Office.

The work requirements don’t stop at individuals covered by Medicaid alone; it also extends to coverage through marketplace subsidies, affecting over 200,000 Wisconsin residents. 

Work requirements used to be required for Wisconsin residents to access coverage through federal waivers, but in 2021 then-President Joe Biden removed the work requirement. 

The labor force participation rate has dipped from about 68% in 2017 to a little over 65% as of May 2025 but has remained higher than the national average, which is about 62%. Some reports suggest that decline is due to the aging workforce in the state.

Work requirements have also been found to increase the uninsured rate.  

The Wisconsin Policy Forum reports that one of the main reasons work requirements may lead to higher uninsured rates is that they are confusing and time-consuming. Some people may choose to get rid of coverage altogether to avoid unnecessary paperwork. 

What could happen with the federal bill?

The Kaiser Family Foundation also found that implementing work requirements will be costly for states, costing anywhere from $10 million to over $270 million, depending on the size of the state. DHS estimates the state will pay $6 million annually to implement work requirements, while receiving a lower federal match rate than fully expanded states to reimburse for administrative costs.

With a lower federal match rate, Wisconsin has increased Medicaid funding through hospital taxes, which the new state budget just increased from 1.8% to the federal maximum of 6% for the 2025-27 biennium budget.

Republican lawmakers in the state were quick to approve the hospital tax increase, despite their previous opposition to Medicaid expansion as a means for drawing down additional federal funding. If they hadn’t, the state’s 1.8% tax would have been frozen under Trump’s big bill. The increase will raise some $1 billion more annually in federal matching funds that the state can use to pay hospitals for care they provide Medicaid patients.

States that expanded will not lose the 90% federal match rate, but those like Wisconsin that didn’t will now miss out on an additional incentive to expand created during the Biden administration.

The incentive would have raised the federal match rate to 95% for two years, but was eliminated by Trump’s big bill. Instead Wisconsin will remain at about 60% reimbursement, while still facing the same bureaucratic requirements as expansion states.

Wisconsin still losing out from not expanding Medicaid — even under Trump’s big bill is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

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Wisconsin lawmakers and Gov. Tony Evers approved a $111 billion state budget early Thursday morning that will increase spending on child care and the Universities of Wisconsin system, while cutting taxes by $1.5 billion. 

The budget was the first since Democrats gained 14 seats in both chambers of the Legislature under new legislative maps and reflected a stronger bipartisan compromise than in previous cycles. 

Senate Republicans, with only one vote to spare, needed Senate Democrats at the negotiating table to pass the budget after multiple Republican senators indicated their disapproval with the budget. Four Republican state senators voted against the budget, and five Democratic state senators voted for it.

The budget was approved in both chambers on Wednesday evening and signed by Evers after 1 a.m. because lawmakers wanted to finish the state budget before President Donald Trump’s big federal bill passed. The federal bill capped Medicaid reimbursement for state taxes on hospitals at 6% and would have frozen tax rates on states like Wisconsin, which previously was at 1.8%. The move helped Wisconsin secure $1.5 billion in additional federal funds.

Evers called 2025 the “year of the kid,” prioritizing more funding for child care, K-12 education — particularly special education reimbursement — and higher education. While those areas received significant funding increases, and Republicans got their desired tax cut, postpartum Medicaid extension, renewal of the popular Knowles-Nelson public land acquisition fund and several other items, many with bipartisan support, were missing from this budget.

Postpartum Medicaid eligibility not extended to a year

Notably missing from the budget is extending postpartum Medicaid coverage to 12 months — an item that every single senator on the budget committee voted for when it was last brought before the Senate. 

“The governor called this budget the ‘year of the kid,’ and the year of the kid really needs to include mothers and parents and their mental health because the first indicator of a child’s well-being is their parents’ mental health, their mother’s mental health,” said Casey White, marketing and communications manager for Moms Mental Health Initiative. 

Evers asked for the state to allocate over $24 million to extend postpartum Medicaid eligibility to 12 months. Advocacy groups and women’s health experts say the most risky time for a mother’s health is six to nine months postpartum, but eligible new mothers currently only receive about two months of coverage. 

Wisconsin is one of only two states that do not extend eligibility for 12 months, despite the severe maternal morbidity rates rising in the state and increases in perinatal depression diagnoses. 

Extending postpartum Medicaid has received bipartisan support in both the Senate and Assembly. In April, the Senate passed a stand-alone bill that would extend postpartum Medicaid coverage. But the bill has stalled in the Assembly. 

Former Rep. Donna Rozar, R-Marshfield, told Wisconsin Watch in January she authored the bill because she wanted to support new mothers. Even with bipartisan support in his chamber, Assembly Speaker Robin Vos, R-Rochester, refused to schedule it for a hearing last session. 

This time around, Joint Finance Committee Republicans did not remove Evers’ proposal to extend postpartum Medicaid eligibility from budget consideration, meaning the committee could have introduced and passed a motion including the provision. 

But as the committee wrapped its work last Tuesday, the extension was missing. Now, the stand-alone legislation awaits an unlikely hearing in the Assembly. 

Child care provisions enough?

Late in the budget process it became clear that one of Evers’ highest priorities was funding a child care program supported by expiring federal pandemic relief dollars. The budget includes more than $361 million to fund direct payments to providers, increase child care subsidies for low-income families and fund an early school readiness program.

While the bipartisan willingness to address the ongoing issue of child care access in the state is a significant step, Ruth Schmidt, executive director of the Wisconsin Early Childhood Association, explained the $110 million in direct payments to providers is far from enough to stabilize the field. 

Another critical part of the budget was the early school readiness program. Schmidt said allocating general purpose revenue to this program demonstrates lawmakers trust in the provider community to supply a school readiness curriculum to families around the state.

The third major piece of funding approved this budget cycle is raising the Wisconsin Shares child care program to the 75th percentile of market rates, allowing low-income families to access affordable, quality care. 

“I always will argue that we can do more, and we can and other states do more, but for us to be at a place where we are restoring payments to 75% of the market is hugely important,” Schmidt said. 

Schmidt noted that not all of the provisions are what is recommended by child care advocates, particularly the ratios of children to caretakers. 

The budget would increase the class size for 18- to 30-month-olds by instituting a ratio of one caregiver to seven children rather than the recommended one-to-four. Schmidt said that is not something WECA would stand behind as best practice in the state and is not necessarily the right move for long-term investment into child care.

WECA is preparing to provide additional training to the facilities that take on this pilot program over the biennium. 

Environmental advocates look to fall session for stewardship, PFAS fund

Two major environmental initiatives — reauthorization of the Knowles-Nelson Stewardship Fund and increased funding for the PFAS trust fund created in the last budget cycle — failed to make it into the final budget.

But Republican lawmakers have shown a willingness to reauthorize the stewardship fund, with a separate bill by Rep. Tony Kurtz, R-Wonewoc, and Sen. Patrick Testin, R-Stevens Point, aiming to fund the stewardship program through 2030. The fund supports land conservation and outdoor recreation through grants to local governments and nonprofits and also allows the Wisconsin Department of Natural Resources to purchase and maintain state land. 

Sen. Jodi Habush Sinykin, D-Whitefish Bay, shared her disappointment that the budget deal did not reauthorize the stewardship fund and pointed to it as one of the reasons she voted against the budget. 

“Beyond the long-time importance of this program to me personally, Knowles-Nelson funding has stood out as the single-most popular issue I have heard from my constituents during my first six months in office – from voters across the political spectrum,” Habush Sinykin said.

The state Supreme Court recently limited the power of the state budget committee to block conservation projects. Although funds for the program are currently set to expire on June 30, 2026, most funds are already awarded, and a lapse in funds could impact planning for land trusts and local governments hoping to access the funds, according to the program.

Paul Heinen, policy director at environmental policy organization Wisconsin Green Fire, and a lobbyist for the first stewardship fund in 1989, said the battle over reauthorization mirrors past debates over the fund. 

“The stewardship fund is, could very well be, the single most loved state program,” Heinen said. “But oftentimes it’s leadership who says, no, we’re spending too much money. We’re not going to spend money on this, and then invariably, the other 120 legislators overrule them at some point, and the stewardship fund is reauthorized. That’s where we’re at right now.”

Heinen said he was “99% sure” the fund would be reauthorized in future legislative sessions but was uncertain at what level the fund would be restored. Evers’ budget proposed reauthorizing the fund with $100 million of bonding authority per year through 2036. The Republican bill proposes $28 million per year for the next four years.

UW system funding rebounds with some strings attached

Just two weeks ago, Republican lawmakers floated an $87 million cut to the Universities of Wisconsin budget, yet in the final deal between lawmakers and Evers, the system will see a $256 million increase, the largest increase in over two decades. 

Republican lawmakers conditioned their support for additional funding on several things, including a required transfer credit policy between system schools, the continuation of a cap on state-funded positions and workload requirements for faculty. 

UW-Madison faculty advocacy group PROFs celebrated the increased funding for the system, but called the updated workload requirements an overreach “that would intrude on the responsibilities of both institutions and their faculty members.” 

The budget also specifies certain funding to be directed toward lower-enrollment universities. The funding formula the UW system uses to distribute state aid among schools has been a source of controversy among Republican lawmakers who have argued for more transparency. 

Jon Shelton, president of AFT-Wisconsin and professor at the University of Wisconsin-Green Bay, said he was frustrated faculty and staff were not part of negotiations over work requirements.

“It takes something that otherwise could have been, I think, relatively positive for the UW system and created a poison pill that was unnecessary,” Shelton said. 

Although the $256 million increase is a significant boost to the system, the funding is only a fraction of the $856 million that Evers and UW requested. 

UW system President Jay Rothman had indicated that if the $856 million request was fulfilled, the remaining two-year branch campuses, several of which have closed in recent years, battling funding shortfalls and enrollment decreases, would stay open, and tuition would not increase. System spokesperson Mark Pitsch did not respond to a request for comment on the potential impacts on branch campuses or tuition.

DAs but no public defenders

Republicans voted to increase assistant district attorneys in Wisconsin counties, notably adding seven ADAs in Brown County, but they didn’t add any public defender positions. Without filling these positions, the American Civil Liberties Union reports current public defenders are overburdened and cannot conduct thorough investigations into a case. 

Brown County already faces a backlog of cases, with reports saying there has been an increase of over 2,000 open criminal cases in the past decade. While adding ADAs may allow the prosecutors to bring more cases to the courts, failing to add public defenders will not address the backlog of criminal cases. 

That means as more cases are presented by ADAs, there might not be enough public defenders to actually represent the individuals, so those accused of a crime may spend more time in jails as they await an attorney. 

Republicans also added 12.5 ADA positions in Milwaukee County. 

Milwaukee has been addressing backlogs but still faces challenges. By adding more ADAs to bring cases forth, while ignoring a shortage of public defenders, backlog challenges could be exacerbated.

Here’s what didn’t make it into Wisconsin’s $111 billion state budget is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.