Wisconsin healthcare advocates have been worrying for months that new work requirements for some people on Medicaid that will take effect next year will make it harder for people who are eligible to get on, or stay on, the health insurance program.

Those worries increased this week now that the federal government has issued its rules for states to implement the new requirements.

“More people are going to have a harder time complying with the bureaucracy, and they’re going to get caught up in that,” William Parke-Sutherland, government affairs director at Kids Forward, told the Wisconsin Examiner Tuesday. Kids Forward is a Wisconsin research and advocacy organization for children and families of color and facing barriers to opportunity.

Medicaid — known as BadgerCare in Wisconsin — provides health insurance primarily for people with incomes below the federal poverty guideline: $15,960 for one person and $33,000 for a household of four. Medicaid is regulated and partially funded by the federal government, with the states administering the program and sharing responsibility for its costs.

Work requirements were among changes to Medicaid included in HR 1, the tax and spending megabill that congressional Republicans passed a year ago and President Donald Trump signed July 4, 2025. HR 1’s cuts to Medicaid will total more than $900 billion over 10 years, according to KFF, a health policy research and news nonprofit.

The new Medicaid work requirements apply to people who were added to the program as a result of Medicaid expansion under the Affordable Care Act, the federal health insurance law enacted in 2010.

Under the ACA, states were able to get additional federal funds by expanding Medicaid to cover families with incomes up to 138% of the federal poverty guideline — $45,540 for a family of four.

Wisconsin didn’t adopt the full ACA expansion, however. Instead, under former Gov. Scott Walker, the state extended Medicaid healthcare coverage to childless adults with annual incomes up to $15,960, the  federal poverty guideline.  

About 190,000 childless adults in Wisconsin were covered by BadgerCare in April, according to the state Department of Health Services. Nationally at least two-thirds of people under Medicaid expansion are already working, Parke-Sutherland said. 

Starting in 2027 those additional Medicaid recipients must show they are working or engaged in community service at least 80 hours a month, or enrolled in an education program at least part time. The 2025 tax-cut law provided exemptions for people with disabilities or in frail health, as well as for pregnant women and caregivers for other people with disabilities.

The federal rule that the Centers for Medicare & Medicaid Services issued Monday outlines how states must implement those requirements.

“We have been preparing to implement the requirement for almost a year based on limited verbal guidance we received from CMS as well as information we learned by collaborating with other states and learning from their approaches,” Elizabeth Goodsit, spokesperson for the Department of Health Services, said Wednesday.

DHS has spent months developing policies, procedures and system changes to implement the requirement, Goodsit said. “Our goal is to reduce the administrative burden on current and future Medicaid members to meet the new federal red-tape work requirements.”

Healthcare advocates contend that stringent terms in the newly released federal rule will make it more difficult for people to remain covered by Medicaid, even if they fully qualify.

For example, the rule presents “a much more restrictive definition of ‘medically frail’ than what appears to be in the statute of HR 1, and what people had been hearing from CMS,” Parke-Sutherland said.

Advocates said the rule also makes qualifying for an exemption more complicated for people with disabilities.

“We’re looking at how many people with disabilities aren’t going to be qualifying for an exemption and are at risk for losing their healthcare,” said Tamara Jackson, public policy analyst for the Wisconsin Board for People with Developmental Disabilities.

Unpaid family caregivers are supposed to be exempt, but Jackson said the relevant language in the federal rule “is, I think, really confusing and really difficult for unpaid family caregivers [to navigate].”

Jackson said the state will face “a tremendous amount of problem-solving that has to be done in a very short amount of time.” 

It appears the federal rule doesn’t permit states to automatically declare a person exempt from the work requirement on the basis of a particular illness or diagnosis — such as Parkinson’s Disease, multiple sclerosis, HIV-AIDS or cancer.

Many of those conditions are cyclical, with patients alternating between times when symptoms seem mild and times when they’re deeply debilitating, Parke-Sutherland said.

Patients “[are] going to have to prove that they can’t work in order to qualify” for coverage, he said. “That’s a big change, and it’s going to make it harder for individuals and it’s going to make it harder and more costly for the state.”

In a statement issued earlier this week, Lisa Lacasse, president of the American Cancer Society Action Network, said the new restrictions collide with cancer patients’ essential need for health coverage.

“Knowing 1 in 3 children diagnosed with the disease and 1 in 10 people with a history of cancer currently count on Medicaid for their health insurance, this coverage is a matter of life or death for millions of people nationwide,” Lacasse said.

The restrictions in the new federal rule “link the definition of medical frailty to a person’s ability to work,” Lacasse said. The “debilitating side effects of the disease or treatment” complicate the task of fulfilling a work requirement or proving they can’t work, however.

Many cancer patients want to work between rounds of chemotherapy, she said, but instead, they “will have to choose between losing their Medicaid coverage, working the required 80 hours per month, or giving up working altogether to qualify for an exemption.”

Parke-Sutherland said the work requirements alone are expected to cut Medicaid nationwide by $326 billion over 10 years.

“That will not make people healthier and will not make people more likely to work,” he said. “The only way it reduces costs is because people who are currently eligible are not going to be eligible any more, not able to prove they’re working, not able to prove they have a condition [that makes them exempt], or they’re going to get caught up in the bureaucratic red tape of trying to prove those things.”

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A new report forecasts that changes to Medicaid enacted in 2025 will cut $7 billion from the program in Wisconsin alone over the next 10 years, according to the advocacy group Protect Our Care.

Calculations last year from KFF, a nonprofit, nonpartisan healthcare policy and news organization, indicate that at least 57,000 more people in Wisconsin will become uninsured by 2034.

“Wisconsinites and people everywhere have either lost coverage or they’re living with the ongoing fear of not knowing whether or not they’ll have health coverage in the next month,” said state Rep. Deb Andraca (D-Whitefish Bay) in a media call conducted Thursday by Protect Our Care.

The organization has issued a new report on the impact on Medicaid across the country from the 2025 tax cut and spending bill that passed with only Republican votes and was signed by President Donald Trump July 4. The legislation’s tax cuts primarily went to the wealthiest Americans, said Protect Our Care’s Joe Zepecki.

“Every single state in the United States is going to see these cuts and it’s going to have all kinds of consequences,” said U.S. Rep. Gwen Moore (D-Milwaukee), who also took part in the call Thursday.

The legislation included new requirements for some Medicaid recipients to prove they are working or are exempt from a work requirement. It also included requirements that those recipients submit paperwork showing they qualify for Medicaid twice a year instead of once a year.

Those requirements will take effect in 2027. The work-reporting requirements, however, have been broadly criticized by healthcare experts.

“We have also consistently seen in our research and everybody’s research that work requirement policies often do not meaningfully increase employment or access to inclusive, competitive employment,” said Dr. Kiley McLean, a social work professor, researcher and advocate for people with disabilities.

“Instead, they create paperwork barriers that cause eligible people to lose coverage, not because they are ineligible because but because the system becomes too difficult for them to navigate,” McLean said.

McLean said she has heard from people with disabilities and their families who are concerned that they could lose access to Medicaid for healthcare and personal care in their homes and communities.

“For decades, disability advocates like myself have fought to move away from unnecessary institutionalization and toward community living and inclusion,” she said. “Medicaid is what made that possible.”

States can apply waivers to cover those home and community based services — referred to as HCBS for short. But while federal law requires Medicaid coverage for people in institutions, it’s optional for home and community-based care, McLean said.

“That means when states face budget pressure or major Medicaid cuts, community services, HCBS services are among the first at risk,” McLean said.

Another call participant, Dr. Chris Ford, said he has seen the consequences on the job as an emergency room specialist in Milwaukee.

“When access to primary care disappears, when those clinics close, and when people lose that insurance, the emergency department becomes a safety net for an entire — albeit collapsing — system,” Ford said. “We are already seeing the warning signs happening now.”

Ford said he’s seen longer wait times in the emergency room, more patients who, lacking insurance, are “delaying care until they’re critically ill.”

“These cuts disproportionately hurt the very people  who already face the greatest barriers to care to begin with,” Ford said. “This is not something that is a potential. This is something that is happening already.”

This report has been updated.

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Massachusetts and Rhode Island are considering dropping GLP-1 drugs for obesity treatment from their Medicaid programs, continuing a trend of states that have stopped coverage of these expensive medications. 

Thirteen state Medicaid programs are covering GLP-1 drugs for the treatment of obesity this year, down from 16 last year. 

Medicaid programs in California, New Hampshire, Pennsylvania and South Carolina have eliminated coverage of the drugs for weight loss, because the expense strained state budgets. 

In Massachusetts, the governor’s proposed fiscal 2028 budget would not fund the state’s Medicaid program, MassHealth, to cover GLP-1 medications for weight loss alone, though the state would continue covering the drugs for diabetes and other conditions. The legislature is still debating the state budget. 

Rhode Island’s governor also has proposed removing GLP-1 coverage from the state’s Medicaid program for weight loss treatment. 

North Carolina reinstated such coverage in mid-December after having dropped it in October. 

Medicaid programs in Delaware, Kansas, Michigan, Minnesota, Mississippi, Missouri, Tennessee, Utah, Virginia and Wisconsin also cover the drugs for obesity treatment, according to KFF, a health policy research group. 

But some states, such as Michigan, have restricted eligibility for these medications to morbidly obesity patients rather than those who are overweight or obese. The move is expected to save the state an estimated $240 million. 

Meanwhile, lawmakers in Louisiana are debating whether to allow Medicaid to cover GLP-1s for obesity treatment if enrollees have another chronic condition, or comorbidity, such as prediabetes, hypertension or cardiovascular disease.  

The medications generally have been too expensive for people without insurance. In February, one of the largest producers of these drugs, Novo Nordisk, announced it would reduce their list prices to $675 per month in 2027. 

Gross spending on Medicaid prescriptions for GLP-1s — for diabetes as well as for weight loss — has increased from around $1 billion in 2019 to almost $9 billion in 2024 as demand for these drugs has risen, according to KFF. 

At the same time almost 40% of adults and a quarter of children with Medicaid have obesity and may benefit from having access to the drugs, according to KFF. 

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

WASHINGTON — U.S. Senate Republicans approved a budget resolution early Thursday intended to speed the way for billions for immigration enforcement, sending the measure to the House, where GOP lawmakers in that chamber need to adopt it to unlock the reconciliation process. 

The 50-48 vote followed a marathon amendment voting session that Democrats used to highlight policy differences on cost-of-living issues and stalled federal emergency relief dollars for states. 

Alaska Sen. Lisa Murkowski and Kentucky Sen. Rand Paul were the two Republicans to vote against approving the measure. Sens. Charles Grassley, R-Iowa, and Mark Warner, D-Va., did not vote.

Senate Minority Leader Chuck Schumer said just before the vote-a-rama began that Democrats would put Republicans on the record about the soaring cost of living and the Trump administration’s immigration crackdown. 

“America will see even more clearly tonight where the Republicans are — not on the side of lowering costs, but on the side of masked agents occupying our streets,” he said. 

Republicans plan to use the complex budget reconciliation process, which avoids the need for Democratic support in the Senate, to provide between $70 billion and $140 billion in additional funding for Immigration and Customs Enforcement and the Border Patrol.

The money is supposed to cover those agencies for the next three years, avoiding the need for Republicans to negotiate constraints on immigration activities with Democrats, who have been calling for guardrails since federal agents shot and killed two U.S. citizens in Minneapolis in January. 

When combined with the Senate-passed bill that funds the vast majority of the Department of Homeland Security for the current fiscal year, the two pieces of legislation are expected to end the ongoing shutdown at that department, which began in mid-February. 

One amendment adopted, 15 turned down

Senators ultimately debated 16 amendments, 12 offered by Democrats and four proposed by Republicans. The only one adopted was from South Carolina Republican Sen. Lindsey Graham, which senators approved on a 98-0 vote. 

The proposal would create a reserve fund to bolster federal immigration agents’ ability to detain and deport adults who entered the country without proper documentation and were then convicted of rape, murder, or sexual abuse of a minor.

“Everybody in this body should be for this,” Graham said. “These people need to be caught, put in jail, or kicked out of our country.”

Illinois Democratic Sen. Dick Durbin said he supported the amendment because “under current law, undocumented immigrants who are convicted of rape, murder, or sexual abuse of a minor are subject to mandatory detention and deportation.” 

“What we object to is what is happening in the streets of Minneapolis and Chicago,” he added.

SAVE America Act sidelined

Louisiana Republican Sen. John Kennedy tried but was ultimately unable to convince his colleagues to add a new set of instructions to the budget resolution that would have allowed the Rules & Administration Committee to write a voter identification law. 

Kennedy said he wanted that bill to have three provisions. 

“Require that in federal elections, you have to be an American citizen to vote and provide for the provisions to enforce that. Number two, it would require that in federal elections, you have to prove you are who you say you are in order to vote, and it would provide provisions to enforce that,” he said. “Number three, it further instructs the Rules Committee that we’re going to go back to having an Election Day and not an election month, and it instructs the Rules Committee to provide the provisions to enforce that.”

California Democratic Sen. Alex Padilla, the ranking member of the rules panel, opposed the amendment during debate, saying he couldn’t believe lawmakers were once again experiencing a “partisan attempt to rush through what I refer to as a solution in search of a problem.”

“Despite the president’s claims, there is zero evidence of massive voter fraud across the country, which is the premise of these proposals,” he said. “So not only is it a solution in search of a problem, to paraphrase a wise man, this measure is all foam and no beer.”

Padilla added that a provision in Kennedy’s amendment would have required states to count ballots within 36 hours of an election, a new mandate he said could cause considerable problems for larger states with millions of voters. 

“It’s unfortunate elections administration has been turned into a partisan issue,” he said. “I actually ask our colleagues to protect the early voters, not just in my state but in yours. Protect vote-by-mail opportunities, not just in my state but in yours. Let’s protect women who are married and change their name and their right to vote, not just in my state but in yours.”

Senators did not agree to waive a point of order against Kennedy’s amendment on a 48-50 vote. Republican Sens. Susan Collins of Maine, Mitch McConnell of Kentucky, Murkowski and Thom Tillis of North Carolina voted with Democrats. 

Ban on Planned Parenthood funding via Medicaid

Missouri Republican Sen. Josh Hawley tried unsuccessfully to create a pathway to extend the one-year prohibition on Medicaid funding to Planned Parenthood that the GOP included in its “big, beautiful” law. That funding ban expires on July 4. 

Hawley didn’t speak about abortion access during debate but focused his criticism of the organization on gender-affirming health care services for transgender youth. 

“Under no circumstance should Medicaid money dedicated to the poor and the needy be used for transgender surgeries and treatments for minor children,” he said. “It is a moral outrage. This body has a duty to stand against it.”

Planned Parenthood’s website states the organization provides surgery referrals as well as hormone therapy, puberty blockers and “transition support.”

Oregon Democratic Sen. Ron Wyden argued the amendment represented “Republicans’ latest attempt to strip women of the health care they need and depend on so that they can go score some political points.” 

Senators didn’t agree to waive a point of order against the amendment, which would have allowed it to move forward, by a vote of 50-48. Collins and Murkowski voted with Democrats. 

Private equity and home ownership

Senators rejected an amendment from Oregon Democratic Sen. Jeff Merkley that would have addressed the rising cost of housing after he invoked comments President Donald Trump made during his State of the Union address. 

“We have an opportunity tonight to send a message that we agree with the president, that we have a challenge in home ownership, because home ownership is dying,” Merkley said. “And one of the factors is private equity buying up the homes.” 

Ohio Republican Sen. Bernie Moreno spoke out against adopting the amendment, saying lawmakers have already addressed it in a bipartisan way. 

“I obviously urge my colleagues to oppose this amendment, because we’ve already passed it,” he said. We’ve already solved this problem. In fact, congratulations to all of us. 89 to 10. We banned institutional ownership of single-family homes. I think that’s fantastic.”

The Senate voted in March to approve a bill designed to increase the country’s housing supply, according to reporting from NPR. But since the House has approved a bill of its own, the two chambers will need to work out their differences before any housing bill becomes law. 

Senators did not agree to adopt Merkley’s amendment following a 46-52 party-line vote. 

Disaster relief funds from FEMA

California Democratic Sen. Adam Schiff proposed an amendment that would have addressed stalled funding from the Federal Emergency Management Agency, which he said is “holding more than $3 billion in disaster relief funding for California.”

“But as we debate this budget resolution, I know our state of California is not alone,” he said. “North Carolina is waiting on millions in relief designated for Hurricane Helene in 2024. Kentucky saw landslides and flooding just weeks after Los Angeles County burned. Florida and the Gulf Coast have also been battered. Texas communities under siege from last year’s floods have still not seen the federal relief their communities need and deserve.”

Oklahoma Republican Sen. James Lankford opposed the amendment, saying that while he agrees FEMA funds need to get to communities, the best way to do that is for the House to pass the annual funding bill for the Department of Homeland Security, which the Senate already approved. 

House GOP leaders are holding on to that bill instead of putting it on the floor as they wait for the reconciliation process to play out. That Senate-passed DHS bill funds FEMA and all of the agencies that make up the department except ICE and Border Patrol. 

“Our challenge has been, we’ve been in a government shutdown on DHS now for two months,” Lankford said. “We’ve got to be able to get those funds released. That means we’ve got to get DHS funding completely done for all of DHS. We have FEMA employees that are being paid but they don’t have program dollars that they can actually release.”

The Senate rejected the amendment following a 49-49 vote. Collins, Florida Sen. Ashley Moody and Murkowski voted with Democrats. 

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Doula services aren’t covered by Wisconsin Medicaid – known as BadgerCare – as of April 2026.

Doulas provide emotional support and education around childbirth. Unlike midwives (which are covered), they don’t perform medical tasks.

A Wisconsin Department of Health Services spokesperson confirmed doulas aren’t covered as a stand-alone benefit for Medicaid recipients. 

State law requires the health department to get legislative approval before making changes to Medicaid. Doula coverage has been proposed by Gov. Tony Evers and Democratic lawmakers but has not come to pass.

According to the National Health Law Program, 26 states and Washington, D.C., are actively reimbursing for Medicaid coverage of doula care. Seven more are in the process of doing so.

A 2024 study from the American Journal of Public Health found Medicaid recipients with doulas had a 47% lower risk of cesarean delivery and a 29% lower risk of preterm birth than those without.

This fact brief is responsive to conversations such as this one.

Sources

• DONA International: What is a doula?
• Harvard Medical School: What does a doula do?
• Wisconsin Department of Health Services: Email with Elizabeth Goodsitt, communications specialist
• Wisconsin Legislature: 2017 Wisconsin Act 370
• Department of Administration: State of Wisconsin Executive Budget, February 2025
• Wisconsin Legislature: 2025 Assembly Bill 1085
• National Health Law Program: Doula Medicaid Project
• American Journal of Public Health: Role of Doulas in Improving Maternal Health and Health Equity Among Medicaid Enrollees, 2014‒2023

Are doula services covered under Wisconsin Medicaid? 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 has thousands of assisted living providers. Some are small houses; others are more like apartment complexes. Some take Medicaid, while others require residents to pay out of pocket. It’s a lot to sort through, especially when someone needs care fast. 

Searching “assisted living” on Google pulls up several pages of facilities, many listed under a prominent “sponsored results” section.

Mixed in with actual providers are referral companies that promise a way to compare options. Long-term care referral companies don’t typically charge families for their services. Instead, they often receive money from facilities they recommend.

Wisconsin lawmakers in May proposed legislation to make any financial relationships between a referral agency and an assisted living facility clearer. 

Supporters of the bill said disclosure requirements could help families make more informed decisions. Opposing the bill, referral companies argue that they are already transparent and that proposed guardrails would prevent them from helping more families. 

The bill failed to pass before the Assembly adjourned last month. But the debate left me wondering: Where should someone start the search for care?

Aging and disability resource centers

Aging and disability resource centers (ADRCs) can provide objective provider lists for free, alongside information about services and payment options, said Janet Zander, the advocacy and public policy coordinator with the Greater Wisconsin Agency on Aging Resources, Inc. 

The Wisconsin Department of Health Services lists ADRCs by county online. 

ADRCs cannot recommend one facility over another, Zander said. But they can suggest what to look for during a tour. Zander also recommends looking at a facility’s Wisconsin Division of Quality Assurance surveys.

They can also help people identify what kind of care makes the most sense and explore aging at home, said Sara Tribe Clark, the director of the Eldercare Locator, which offers local resources for older adults, people with disabilities and caregivers. 

If you work with a referral agency, ask questions

Tribe Clark recommends asking:

• Do you receive compensation from the providers you recommend?
• Are your referrals limited to certain facilities?
• How do you determine which providers to suggest? What is the criteria for inclusion/exclusion?
• Are there providers in my area that you do not represent?

We want to answer your questions

Getting answers to my own questions is a perk of being a reporter. But I haven’t yet navigated Wisconsin’s aging and disability resources for myself or a loved one. I know I’m missing important questions, so please send me yours, alongside your perspectives.

What has been confusing or frustrating about finding care?

What do you wish you’d known sooner?

What made the process easier?

Even after more than two years reporting on long-term care in Wisconsin, I won’t have all the answers. But I will find experts who do. Email me at acostello@wisconsinwatch.org or call 608-616-5239.

Finding long-term care is hard. Here’s how to start. 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.