U.S. Rep. Derrick Van Orden speaks from the stage at the Republican Party's midterm election convention in Dallas on Sept. 9, 2026. (Screenshot from C-SPAN)
Nearly 900 miles from the southwest corner of his district, U.S. Rep. Derrick Van Orden appeared at President Donald Trump’s Dallas convention Wednesday afternoon to argue that the healthcare policies he and Trump have enacted are benefiting rural Wisconsinites.
Van Orden represents Wisconsin’s 3rd Congressional District and his campaign against Democrat Rebecca Cooke is set to be one of the most hotly contested races in the country as Democrats seek to win back majority control of the House.
During his two terms, Van Orden has been a staunch Trump ally, often taking a bombastic, confrontational tone and drawing criticism from opponents for his treatment of constituents.
But onstage on Wednesday, as Republicans held a rare midterm convention while Trump’s approval rating plummets to record lows and Democrats express confidence they’ll win competitive races across the country, Van Orden and his fellow Republicans sought to sell a softer version of their record.
“Whether you choose to live in a city or a village like my beautiful wife Sarah Jane and I do, you deserve high quality, readily available, and actually affordable healthcare,” Van Orden said. “You know who else knows this? Our great president Donald J. Trump. He is fighting to make quality healthcare a reality for everyday Americans.”
Last year, Van Orden voted for the Trump-signed One Big Beautiful Bill Act. In his speech, he said the bill, and the tax cuts it enacted, brought millions of dollars in funding for rural hospitals in Wisconsin.
“This massive investment would not have been possible without President Trump’s Working Families Tax Cut Act,” Van Orden said. “And shamefully, shamefully, not one Democrat voted for it. So, from Washington to Wisconsin, Democrats spent months demonizing the tax cuts we delivered.”
In fact, the bill made huge cuts to Medicaid, which for Wisconsin will result in losing $7 billion in federal healthcare funds over the next 10 years, an analysis by KFF found last year. In his speech, Van Orden also touted more than $200 million that will go to Wisconsin hospitals because of the law, but that is far less than those hospitals would have received without the Medicaid cuts.
“I worked with President Trump and Republicans in Congress to level up our Medicaid assessments and bringing billions of dollars back to Wisconsin’s Badger Care program,” Van Orden said. “So these investments have made a real difference to real people all over rural America, including back home at Black River Falls Memorial Hospital. It’s where our awesome doctors can now spend less time worrying about the future of the hospital and more time taking care of their patients, who are their neighbors and that they love.”
An analysis conducted last year by the centrist think tank Third Way found that after the enactment of the Medicaid cuts, hospitals in Van Orden’s district are projected to lose more than $42 million in annual revenue.
Van Orden has on several occasions gotten into arguments with constituents over the effect of the law and has falsely denied that Medicaid was cut.
In a statement from her campaign, Cooke noted that Van Orden has never done a town hall in his district, but has time to join Trump in Texas.
“Derrick Van Orden still hasn’t done a single town hall with his constituents in West Central Wisconsin. And lies from Dallas can’t change his record: Derrick Van Orden watched rural hospitals in his district close,” Cooke said. “Then, he voted to cut $7 billion from Wisconsin’s health care so that those funds could go to tax breaks for data centers instead. Congressman Van Orden can continue to defend the Big Ugly Bill all he wants. Folks here in West Central Wisconsin see their health care costs going up and their doctors leaving town.”
Republican members of Congress who are attending the convention had to pay $25,000 to the National Republican Congressional Committee to access a hotel room in the committee room block and tickets to the welcome reception. Paying up to $100,000 earned members additional perks, including breakfast with House leaders. Vulnerable members did not have to pay the five-figure fee, Axios reported.
A spokesperson for the Democratic Party of Wisconsin criticized Van Orden for attending a “lavish” Texas event rather than focusing on solving the problems of his constituents.
“It should come as no surprise that D.C Derrick Van Orden decided to ditch his constituents to go bootlick an administration that is making life unbearably expensive for Wisconsinites,” the spokesperson, Haley King, said. “While Van Orden is out in another state trying to save his re-election campaign and promoting a delusional billionaire cosplaying as President, Wisconsin Democrats are meeting with voters and working to clean up the affordability crisis elected MAGA Republicans like Derrick Van Orden have created.”
A social media post from the Republican Party of Wisconsin showed that U.S. Reps. Bryan Steil and Glenn Grothman, and 7th Congressional District candidate Michael Alfonso, also traveled to Dallas for the convention. Only Van Orden, among Wisconsin Republicans, appeared on the program of speakers.
Districts transport students with disabilities every day under an Individualized Education Program (IEP). The cost recovery opportunities that supports those rides sit in several places at once: school-based Medicaid, Individuals with Disabilities Education Act (IDEA), state categorical aid and grant programs. Knowing which dollars apply, and holding the documentation to claim them, is where most operations lose ground.
In September 2026, Zonar and School Transportation News (STN) surveyed transportation professionals across the U.S. about how their districts fund and document specialized transportation.
Join Zonar and a panel of experts for an open conversation about where the money comes from, what districts document today and what gets missed along the way. Get direct insights from the perspective of consultants, district leaders and the staff who handle claiming.
What we’ll cover:
Where cost recovery for transporting students with disabilities comes from, and which sources districts already use
How school-based Medicaid reimbursement works for specialized transportation, from eligibility through the claim
Why documentation is where most claims break down, and what a defensible ridership record looks like
How one Florida district handles Medicaid claiming today, including the manual matching behind every submission
Where the survey data shows the widest gap between cost recovery options that are available and funding claimed
Practical next steps for transportation and special education leaders heading into the rest of the 2026-2027 school year
How ridership tracking makes applying for cost recovery easier and more reliable.
Brought to you by Zonar
REGISTER BELOW:
Featured speakers:
Rachel Trindade
Chief Marketing Officer
Zonar
With more than 25 years in marketing and 15+ years in logistics, Rachel has helped companies drive significant growth faster than industry norms. At Zonar, she leads marketing and demand generation.
Before joining Zonar, Rachel served as CMO at FlavorCloud and Extensiv, and led global marketing at Teletrac Navman (Vontier) across four continents. She holds a BBA from the University of Texas at Austin and has been recognized as a leading Woman in Supply Chain by Supply & Demand Chain Executive and named California’s Most Visionary Tech CMO by CEO Monthly.
Tim Ammon
Owner
Ammon Consulting Group
Tim Ammon has spent more than 25 years supporting transportation and fleet operations, working with more than 500 organizations across three countries. His work focuses on identifying opportunities to improve operational performance through process improvements, technology adoption, and personnel practices, consistently helping organizations bridge the gap between desired and actual performance.
Tim has also provided extensive professional development services in leadership and management, decision-making, organizational resilience, and cost and technical analysis. He holds a Master of Public Administration from American University and certifications in School Risk Management, Operational Risk Management, and Change Management.
Karen Thomas
Medicaid Coordinator
Leon County Schools
Karen Thomas handles Medicaid claiming for Leon County Schools in Tallahassee, Florida, where she manages the documentation behind every reimbursement the district submits for transporting students with disabilities. Her work covers pulling the daily records, matching each ride to the correct route and the correct student, then compiling the full file for submission.
She brings a ground-level view of what it takes to get funding for transporting students with disabilities, along with the tools and tricks that make her job easier.
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Nebraska and Montana implemented the new work requirement rules for Medicaid recipients earlier this year.
In Nebraska, officials say there’s been confusion about basic eligibility, with some people who should have received exemptions being denied coverage due to procedural errors.
Montana leaders stressed the importance of communication, particularly to Native American tribes, who should be exempt from the new rules.
Officials in Wisconsin say they’re implementing ways to automatically determine whether someone is working or if they’re required to follow the new rules.
Federal officials also narrowed the definition of medical frailty, meaning that people who have Medicaid because they are too medically frail to work will be required to prove their condition and the fact that it prevents them from working.
Starting in January, some Wisconsinites must prove they meet federal work requirements to enroll in Medicaid. Around 63,000 people are at risk of losing coverage, state officials say. It’s part of an effort by the Trump administration to reduce “waste, fraud and abuse” in the program and reduce federal spending by $326 billion over 10 years.
As Wisconsin prepares to implement the measures detailed by the One Big Beautiful Bill Act, states like Nebraska and Montana have already put work requirements into effect. How the process is unfolding offers key lessons for states like Wisconsin facing a Jan. 1 deadline.
Who needs to meet work requirements?
The new Medicaid requirements apply to states like Nebraska and Montana that voted to expand Medicaid to families living at 138% of the poverty level — with the exception of a few states that submitted a waiver to partially expand Medicaid, like Wisconsin.
That program, called BadgerCare Plus, applies to individuals who live at or below the federal poverty level — $33,000 annually for a family of four — as compared to the $45,540 income limit for expansion states.
Only childless adults aged 19 to 64 under the BadgerCare Plus program must meet work requirements — about 200,000 people, according to state officials. That means parents of dependent children under age 19 and people with coverage other than BadgerCare Plus, such as SSI Medicaid or home- and community-based service programs, are exempt.
Other exempt groups include Native Americans, pregnant or postpartum people, caregivers of young children or disabled individuals, veterans with a total disability rating, participants in addiction or rehab programs, and those too medically frail to work.
Starting Jan. 1, 2027, new BadgerCare Plus applicants must show they worked, volunteered or attended school for at least 80 hours in the previous month, or prove they were exempt for that month.
Current BadgerCare Plus members will face the requirements beginning in March 2027. They must show they met the work requirement in any one month of the last 12, or that they are exempt. They can show they received at least $580 in income in a single month or completed combined activities adding up to 80 hours.
In July, Wisconsin Department of Health Services Secretary Kirsten Johnson told reporters officials aim to automate the process as much as possible.
Those system changes will cost an estimated $10 million in the first year, Wisconsin Medicaid Director Amanda Dreyer confirmed, which will be split between the state and federal government.
(Courtesy of KFF)
Nebraska’s early lesson
Nebraska became the first state to implement the new requirements on May 1.
Officials began to disenroll Nebraskans who didn’t meet the requirements on Aug. 1. Nebraska Medicaid Director Drew Gonshorowski told Tradeoffs in July roughly 200 people could lose coverage on that day. The state Department of Health and Human Services has not released official numbers.
The state sent more than 75,000 letters, 38,000 text messages and 10,000 emails to notify people of the change. Amy Behnke, CEO of the Health Center Association of Nebraska, told Wisconsin Watch some residents still had basic eligibility questions.
“There’s some confusion over who the work requirements apply to and who they don’t apply to,” Behnke said. “The communication that went out from the state was pretty lengthy. It was about four pages long and at a collegiate reading level, and so it was a lot for somebody to digest.”
It’s also hard to know whether someone is part of the Medicaid expansion without contacting the state directly.
“Our health centers don’t have a really good way of being able to look that up,” she said.
Her organization supports Nebraska’s federally qualified health centers, which provide low-cost medical care and help people apply for Medicaid.
She’s already seen patients have their Medicaid applications denied due to procedural errors. One woman was denied because she didn’t meet work requirements — even though pregnancy made her exempt.
“She was able to get her Medicaid restored,” Behnke said. “But that’s always been our fear – that somebody’s not going to know that they’ve lost their coverage until they show up to pick up a prescription or they show up for a medical appointment.”
A stethoscope sits on a table at the Bread of Healing clinic on Nov. 24, 2025, in Milwaukee. Officials in Nebraska, who implemented work requirements early, say they’ve had to work through issues like figuring out whether someone is part of the Medicaid expansion population or if they were denied coverage because of a procedural error. (Jonathan Aguilar / Milwaukee Neighborhood News Service / CatchLight Local)
Residents can call the state’s Medicaid help line, but wait times have stretched as long as 90 minutes, Behnke said. She recommends states consider hiring additional caseworkers, which Nebraska has not done.
“They are hardworking individuals (at the call center), and there is just an additional load of work and information that’s needed that comes with these requirements,” Behnke said.
Wisconsin DHS plans to use the additional FoodShare staff secured last year to help with implementing Medicaid requirements, Johnson said, noting the increased budget will add flexibility for other staff to help Wisconsinites.
Behnke urged Wisconsin to prioritize flexibility in implementing the program. She highlighted that Nebraska requires members to meet requirements in just one month of the last 12 and allows individuals to self-attest to medical frailty — policies Wisconsin DHS confirmed it will follow.
A balancing act in Montana
Montana also implemented work requirements on July 1 — the first state to do so after the U.S. Centers for Medicare and Medicaid Services released stricter guidelines on medical frailty. For three months, Montana enrollees won’t be penalized if they fail to document community engagement hours.
Dr. Aaron Wernham, CEO of the Montana Healthcare Foundation, said the effects won’t become clear until Oct. 1 – the first day the state begins to disenroll people. The foundation estimates 29,000 people could lose coverage.
Wernham said it remains unclear how Native Americans, who are exempt from the requirements, will be asked to document their status. The state had limited interaction with the tribes and other stakeholders on how to communicate the change, he said, and urged Wisconsin officials to engage those groups now.
Wisconsin could improve implementation by working with partners such as Covering Wisconsin to develop forms, define medical frailty and plan outreach, Wernham said.
Montana has effectively automated systems to determine whether someone is working, Wernham said. But automatically verifying medical exemptions has been more difficult as officials struggle to access claims data, the Montana Free Press reported.
Defining medical frailty
The challenge comes as federal officials have tightened the definition of medical frailty. Rather than automatically exempting people with certain medical conditions, the rules require people to prove their condition and show that it significantly prevents them from working.
The tightened medical frailty definition has overshadowed concerns over Montana’s ability to automate processes, Wernham said.
“There are many patients with cancer that may have a disease that will be lethal if not treated, and yet they might not be too sick to work,” Wernham said. “The real question is, what’s going to happen with those people who have a very serious illness, any doctor would consider them medically frail, and yet it may be hard to say they’re too sick to work?”
An exam room is seen at the Mayo Clinic Health Systems clinic in Arcadia, Wis., on Sept. 19, 2019. The area’s hospital closed in 2011, and this clinic was built to meet the needs of the area’s rural residents. Officials expect rural hospitals to be hit the hardest by Medicaid cuts. (Coburn Dukehart / Wisconsin Watch)
For the first year, people can self-attest that they are too medically frail to work. Wisconsin officials confirmed DHS will rely on self-attestation and existing diagnoses codes, reassuring providers they would not have to determine medical frailty. But in 2028, states will have to determine how to verify those exemptions while risking federal audits.
Montana and other states should outline their plans for monitoring who is disenrolled from Medicaid and the potential impacts, Wernham said. That’s something Wisconsin has done by announcing that roughly 63,000 are at risk of losing Medicaid due to a lack of work history on file.
“States aren’t always eager to share their data, especially if it doesn’t look good with the public,” Wernham said. “But the fact is that transparency with regard to data on this program leads to better government.”
State budget woes
Medicaid funding is often the largest source of federal funds for states, so it can have a big impact on their budgets. State Medicaid budgets could be reduced by an estimated $665 billion through 2034 under the One Big Beautiful Bill Act.
This leaves officials with few choices: raise taxes, cut other programs or cut Medicaid — which would mean reducing provider rates or limiting benefits or coverage. The Congressional Budget Office estimated 10 million more people will be uninsured nationwide by 2034 as a result of the new law.
The cuts could affect the entire health care system, even those who are insured, said Vaishu Jawahar, director of policy programs at the national health care advocacy nonprofit Protect our Care.
Programs could be cut or premiums will increase because hospital budgets will be strained. Hospitals could face more uncompensated care as more uninsured patients seek treatment, tightening budgets and potentially increasing costs for privately insured patients.
Jawahar said people who lose insurance may forgo preventive care until their conditions become severe enough to require emergency treatment.
“They’re still going to have to provide care to uninsured people who will come in sicker,” Jawahar said. “… And so, how do hospitals make up for that? They will have to hike costs on people with employer-based insurance.”
Medicaid cuts are expected to hit rural hospitals hardest. A March report by Public Citizen found 446 hospitals nationwide were at risk of closing or reducing services due to cuts. Samantha Peck, rural hospitals and clinics program manager for the Wisconsin Office of Rural Health, manages funds that benefit critical access hospitals across the state.
About 13% of patients in Wisconsin hospitals use Medicaid, but Peck said critical access hospitals in Door County, Oconto, Shawano and New London average about 48% of patients on Medicaid, leaving them particularly vulnerable if more patients lose coverage.
Maternal and mental health programs could be among the first cut, Peck said.
“The biggest worry is that community hospitals will start reducing service lines,” Peck said. “What we’re already seeing is a reduction in maternal care, specifically labor and delivery.”
The NorthEast Wisconsin Community Clinic mobile unit is parked across the street from St. John’s Park on June 18, 2026, in Green Bay, Wis. Clinic leaders said 47% of its clients were on Medicaid in 2025. As a result, they are using the mobile unit to educate people about the coming work requirements. (Joe Timmerman / Wisconsin Watch)
Clinics prepare to help Wisconsinites navigate changes
NorthEast Wisconsin Community Clinic, a free and low-cost health center in Green Bay, is educating people about the new requirements with its mobile outreach vehicle.
In 2025, 47% of the center’s clients were on Medicaid, which means it’s preparing its budget to receive less federal reimbursement next year. Executive Director Kim Franzen said the clinic will continue serving the uninsured.
“While I’m concerned, I want to make sure that as a health center, it’s our responsibility to take care of people regardless of their ability to pay,” Franzen said.
Franzen worries people might not realize their coverage was denied before racking up medical bills.
“If you lose your Medicaid, now a person could potentially have four therapy sessions (before realizing) that ‘Oh, I didn’t know my coverage lapsed,’ and then as an organization, we have to step back and go, ‘OK, so do we bill the person? Do you write off the expenses?’” she said.
Adam VanSpankeren is the navigator program manager for Covering Wisconsin, which receives federal funding from the Affordable Care Act Navigator Program and responds to calls about health insurance.
Despite recent funding cuts, VanSpankeren hopes people affected by the changes call Covering Wisconsin for help.
“I don’t love that people are affected, but that means we’re going to be able to help those people,” VanSpankeren said. “It’s the people that don’t call us that I worry more about.”
A baby crawls on the carpet at the Alabama Birth Center in Huntsville, Alabama. In 14 states, the closure of the closest rural hospital or its obstetric unit would force Medicaid patients to drive an hour or more to get to another hospital that provides inpatient maternity care, a new study says. (Photo by Eric Schultz for the Alabama Reflector)
In 14 states, the closure of the closest rural hospital or its obstetric unit would force many Medicaid patients to drive an hour or more to get to another hospital that provides inpatient maternity care, according to an analysis released this week.
Nationwide, the median drive time between hospitals providing inpatient maternity care to Medicaid enrollees and the closest in-state alternative is 43 minutes for rural hospitals compared with 13 minutes for urban hospitals, the analysis found.
The study by KFF, a healthcare research organization, suggests that the closure of rural obstetrics units will accelerate as a result of the healthcare changes included in the broad tax and spending measure President Donald Trump signed last summer. That law will reduce some payments to hospitals and cut Medicaid enrollment by introducing work requirements.
Already, rural obstetric services are diminishing at a rapid rate: From 2010 to 2022, 238 rural hospitals closed their obstetrics units while only 26 hospitals opened new units. In 2023, almost half of rural counties did not have a hospital offering obstetrics services.
A 2022 report by the Government Accountability Office cited low Medicaid reimbursement rates and the challenge of recruiting and retaining providers as major factors.
Brittni Frederiksen, the lead KFF researcher for the report, said in an interview that rural hospitals already operate on thin margins, and that the additional cuts could push some of them over the edge.
“There are likely going to be rural hospitals that close their obstetric units or have to close the entire hospital, and so people will have greater distances to travel to safely deliver a baby,” said Frederiksen, an associate director at KFF who specializes in women’s health policy.
The states with the longest potential driving times, according to the KFF analysis, are Alaska, Nevada and North Dakota. The other states where the median trip would be an hour or more are Arizona, Colorado, Florida, Hawaii, Massachusetts, Montana, New Hampshire, New Mexico, Vermont, Virginia, and Wyoming.
The states with the shortest drive times are New Jersey, Louisiana, and Ohio.
A lack of access to maternity care can lead to increased maternal mortality, low birthweight and premature births.
The United States has one of the worst maternal mortality rates among higher-income countries, at 17.9 deaths per 100,000 live births in 2024, according to the federal Centers for Medicare and Medicaid Services. The U.S. rate is double, or even triple, the rate in most other high-income countries, according to The Commonwealth Fund, a philanthropic and research group.
Outcomes are even worse for women on Medicaid, the government insurance program for people with lower incomes. A recent survey of Medicaid patients who gave birth in 2023 and 2024 found that those patients experienced more complications, such as high blood pressure and gestational diabetes, than women with private insurance.
“We already have a maternal health crisis in this country, and already have very poor outcomes when it comes to delivering babies safely in this country. And then in rural areas, in particular, people already have to travel long distances to deliver,” Frederiksen said.
“Anytime you increase the distance to delivery, you know the likelihood that it could result in poor outcomes increases.”
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
Starting next year, adults ages 19 to 64 will be required to work, go to school or volunteer for 80 hours per month to qualify for coverage under the safety-net program.
The new rule, which was included in Republicans’ “One Big Beautiful Bill Act” last year, provides exemptions for several groups, including people who are pregnant, live with children under 19 and those with a recognized disability.
There is also an exemption for people with serious or complex medical conditions, or those considered “medically frail.”
In guidance released in June, the Centers for Medicare and Medicaid Services, or CMS, said state Medicaid programs should consider not only a person’s diagnosis or condition but also “the extent to which the condition impairs an individual’s ability” to meet the new requirements.
But Dr. Ken Schellhase, a primary care physician and member of the Wisconsin Medical Society, said making that determination is not simple, even for a doctor.
“That will require training and skills that the typical primary care doc does not have,” he said. “Honestly, that’s a big reason why most docs in primary care practices don’t do the official disability evaluations for Social Security.”
Doctors working in occupational medicine or rehabilitation are specially trained to objectively determine someone’s functional capacity, Schellhase said, but few such providers practice in those fields.
Speaking to reporters on July 30, Wisconsin Department of Health Services Secretary Kirsten Johnson said the state needs more guidance from CMS as it develops a system for verifying who qualifies for the exemption.
She said DHS plans to use existing records like medical billing to verify that someone is unable to meet the work requirements. CMS will also allow recipients during the first year to self-attest that they are unable to work.
Scott Stewart, CEO of the Wisconsin Primary Health Care Association, said the existing system for health insurance claims is not designed to indicate a person’s level of impairment or their ability to work.
“It’s set up to say this is what a patient has, but it’s not set up to say anything more than that,” Stewart said. “You have to really also think about the privacy aspects of that. Now you’re saying that I have to potentially give a patient’s chart, which they have to sign off on in terms of HIPAA, to say that they are medically frail and meet all definitions?”
Schellhase worries that involving medical charting and billing could influence how doctors care for their patients, including how quickly they make a diagnosis. He described someone seeking for treatment of asthma symptoms.
“Not everybody who wheezes has asthma, and so sometimes we struggle with as a diagnosis code,” he said. “Do we put in just wheezing? Or have we seen it enough times, but it’s just not absolutely confirmed that yeah, this person probably has asthma? There’s a lot of gray area in that.”
He said patients with conditions not considered severe enough for exemption could see their health decline if they lose health insurance. And he worries the new process will create a conflict of interest for doctors who have a professional obligation to help, not harm, their patients.
“We’re supposed to be that patient’s advocate, to do whatever’s in our power to help them and get them the help that we think that they need,” he said.
Stewart, whose organization represents the state’s federally supported community health centers, said increasing paperwork requirements have lead to more people losing access to care.
He’s concerned that health systems will be incentivized to help patients qualify for an exemption to keep their coverage so providers can continue to bill the program for care.
“We’ve seen issues with the Medicare Advantage program and things like that in the same way, around wanting patients to have access to these programs, but having the kind of perverse financial incentive to get them on (the program),” he said.
WPR contacted several major Wisconsin health systems for comment on the potential impact of the work requirements but received no responses.
The Wisconsin Hospital Association, or WHA, declined WPR’s interview request. In a statement, WHA’s senior vice president for finance and payment, Christian Moran, said the association appreciates DHS’s efforts to “minimize additional regulatory burdens on hospitals and providers while helping eligible individuals maintain Medicaid coverage and reducing the risk of higher uncompensated care in Wisconsin hospitals.”
Moran wrote that WHA will continue to watch the state agency’s plans as more details become available.
The Wisconsin Department of Health Services is preparing to implement new federal Medicaid work requirements that could put health insurance coverage at risk for tens of thousands of BadgerCare Plus members.
Department of Health Services Secretary Kirsten Johnson and Wisconsin Medicaid Director Amanda Dreyer answered reporters’ questions Thursday about how the state plans to implement the new requirements and what members should do now.
Here’s what you need to know.
Who is impacted
The new requirements were created under the One Big Beautiful Bill Act, which requires states to implement Medicaid work requirements for some adults.
In Wisconsin, the requirements apply to BadgerCare Plus members ages 19 to 64 who do not have a dependent child younger than 19 living with them.
About 200,000 Wisconsin adults will be subject to the new requirements. The agency estimates about 63,000 people are at immediate risk of losing their health care coverage because the state does not currently have documentation showing they meet the requirements or qualify for an exemption.
New requirements
To keep Medicaid coverage, affected members must show they completed at least 80 hours of employment, volunteer work, school, job training or another qualifying activity in a single month during the 12-month period since they were last approved for health care coverage.
Some people may qualify for exemptions, including those who are medically frail or family caregivers, but Department of Health Services leaders say they are waiting for federal guidance on what documentation will be required.
Work requirements will take effect for new Medicaid applicants early next year. Starting in January 2027, new applicants must meet the federal work requirement in the month before they apply.
Current BadgerCare Plus members will be subject to the requirements when they renew their coverage starting in March 2027.
What you can do
State officials say the most important step is making sure the department has current contact information.
Medicaid members should keep their mailing address, phone number and email address up to date to ensure they receive important notices about the upcoming changes. Members can update their information through the ACCESS Wisconsin website or the ACCESS smartphone app.
The department also recommends keeping documentation such as pay stubs, volunteer records or school enrollment information that may be needed during the renewal process.
Where possible, the Department of Health Services plans to use existing medical records and diagnosis codes to identify people who qualify for exemptions rather than requiring new paperwork. During the program’s first year, members who believe they are medically frail may self-attest while the department obtains supporting documentation.
Resident outreach
The Department of Health Services is working with health care providers, counties and community organizations to prepare for the changes, with a particular focus on helping people experiencing homelessness and others who may have difficulty meeting the new reporting requirements.
The department has also created a “Medicaid: New Federal Work Requirement” webpage that it will update with new information about eligibility, exemptions, reporting requirements and implementation timelines.
Johnson said the state’s goal is to ensure everyone who qualifies for Medicaid can keep their coverage despite the new federal requirements.
Department of Health Services leaders estimate the first year of implementation will cost about $10 million in system upgrades. The agency is still finalizing staffing and training costs. Officials say they will continue working with local partners to help members understand the new rules and avoid unnecessary loss of health coverage.
Jonathan Aguilar is a visual journalist at Milwaukee Neighborhood News Service who is supported through a partnership between CatchLight Local and Report for America.
Dr. Mehmet Oz, administrator of the federal Centers for Medicare & Medicaid Services, speaks at the Department of Health and Human Services in Washington, D.C., in December. The U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services announced Tuesday that they are freezing more than $1 billion in Medicaid payments to California and Minnesota in an effort to crack down on fraud. (Photo by Alex Wong/Getty Images)
The Trump administration announced Tuesday that it is freezing more than $1 billion in Medicaid payments to California and Minnesota in an effort to crack down on fraud.
Medicaid is the public health insurance for people with low incomes, including some disabled and elderly people, jointly funded by state and federal dollars.
The U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services deferred more than $867 million to California and $199 million to Minnesota. The feds say they need more documentation from those states to support some Medicaid claims for services that are at high risk for fraud.
The freeze marks the latest round of withheld payments as the Trump administration continues its crackdown on suspected fraud in publicly-funded social service programs, mostly focusing on Democratic-led states. Earlier this year, the Trump administration launched a fraud task force to look into potential waste or abuse in publicly-funded benefits programs, explicitly naming states such as California, Colorado, Illinois, Maine, Minnesota and New York.
The Trump administration has already deferred Medicaid payments in Minnesota twice this year, totaling nearly $400 million. The deferral process, under which the federal government can withhold funding when questioning claims already billed to Medicaid, had never been used to deny funding for entire service areas until a $243 million deferral in February, the Minnesota Attorney General noted.
A letter delivered Tuesday from CMS to the Minnesota Department of Human Services stated that $195 million of the deferred $199 million comes from specific providers that CMS identified as high-risk for fraud or “aberrant billing practices” based on historical billing and analysis. The money comes from services delivered from January through March and has already been paid. States will have to provide documentation backing up the claims or be forced to reduce future billing to the federal government.
The Trump administration has also threatened to withhold $2 billion in annual Medicaid funding to Minnesota in a separate process. The funding fight in Minnesota centers on 14 Medicaid services deemed high-risk to fraud and are largely designed to give long-term care for elderly and disabled people. But state officials have said that funding freezes could deliver a serious blow to the state’s Medicaid program more generally, which cost $18 billion in 2024 and covers other low-income Minnesotans.
John Connolly, temporary commissioner and state Medicaid director for the Minnesota Department of Human Services, said in a statement that Tuesday’s deferral reflects the federal government’s “unprecedented and punitive ways as part of their war on Medicaid and its recipients.”
“CMS touts their new fraud-detection capabilities, yet has not provided data or explanation on how the deferral amount was calculated or what it was based on. I respectfully ask the federal government to partner with us and share any information about their methods to identify potentially fraudulent providers in Minnesota,” Connolly said.
The federal-state fight over Medicaid funding has affected thousands of Medicaid providers in Minnesota, who were abruptly cut off from funding as the state raced to reach a federal deadline to screen all providers in the “high-risk” services. Providers and their advocates said the process was rushed and left legitimate providers unable to get paid for delivering services to vulnerable Minnesotans.
HHS Secretary Robert F. Kennedy Jr. said the Trump administration’s goal is to strengthen the integrity of the Medicaid program and make sure federal funds are spent appropriately.
“States that receive federal Medicaid funding must demonstrate that every dollar meets federal requirements,” Kennedy said in a news release on the deferred funds. “When they cannot, we will not release federal funds until they do.”
California Gov. Gavin Newsom, a Democrat, called the withheld funds a “recycled political stunt” in a post on X, and said his state was being targeted for political reasons.
Minnesota Democratic Gov. Tim Walz rejected the Trump administration’s framing of the situation in a post on X: “This isn’t about fraud — it’s about cutting your healthcare so that Trump can afford the tax cuts he gave to billionaires.”
CMS said it identified unusually high growth in spending on certain in-home care programs in California, triggering the hold on that state’s funds. It has not provided proof of fraud.
Newsom countered in his X post, arguing that California is saving taxpayer money “by keeping seniors and people with disabilities out of far more expensive nursing homes.”
In Minnesota, a CMS review flagged expenditures that raised “potential eligibility or billing concerns.”
“CMS is done trying to chase down stolen and misused funds after they’ve already left the building,” Dr. Mehmet Oz, CMS administrator, said in a news release, adding that the deferred payments are part of a “proactive new approach to program integrity.”
The pauses in funding don’t affect who is eligible for Medicaid, and they’re not permanent cuts.
Alyssa Chen of the Minnesota Reformer contributed to this story. Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
Wisconsin will begin enforcing new federal eligibility restrictions for FoodShare and Medicaid this week, cutting off thousands of refugees, asylees and other legally present immigrants from public benefits they were previously eligible to receive.
The state’s refugee services providers warn that fallback options are already stretched thin.
The Trump administration narrowed eligibility for the federal Supplemental Nutrition Assistance Program (SNAP), which helps low-income households purchase groceries. The Wisconsin program, called FoodShare, is federally funded but administered by states. The new rules — which President Donald Trump last July signed into law as part of his “big beautiful” spending bill — exclude many noncitizens previously eligible for the program, including refugees, asylees and victims of human trafficking.
Wisconsin’s Department of Health Services (DHS) will begin enforcing the FoodShare eligibility rules on July 1, barring immigrants who fall into one of the now-excluded categories from enrolling in the program or renewing their benefits. The state will implement the Medicaid eligibility restrictions beginning Oct. 1, with some exceptions. DHS estimates roughly 7,200 people will lose access to one or both programs, nearly two-thirds of whom live in greater Milwaukee.
Neighboring states have already begun enforcing the new SNAP restrictions. Illinois, for instance, began barring refugees and asylees without green cards from the program in April. DHS spokesperson Elizabeth Goodsitt attributed Wisconsin’s slower rollout to the state’s “complex, combined eligibility system” and effort needed to “design and implement” changes.
Refugee services providers spent months bracing for impact, receiving formal notice of the cutoffs at roughly the same time as affected refugees and asylees. To ensure language barriers didn’t leave families in the dark, Lutheran Social Services of Wisconsin and Upper Michigan refugee program director Omar Mohamed said his team is checking in with affected households individually.
Those with green cards will retain access to the programs, but Mohamed noted that a recent barrage of visa restrictions leaves green cards out of reach for many recent arrivals. Refugees can typically apply for green cards a year after settling in the U.S., but the Trump administration in January froze green card processing for anyone from 39 countries — including Myanmar, the largest source of refugees resettled in Wisconsin in recent years. Of the nearly 170 people Lutheran Social Services resettled in Wisconsin between October 2024 and September 2025, only one has secured a green card, Mohamed said.
Ongoing legal battles over the visa restrictions have yet to clear the path to legal permanent residency.
Without access to legal permanent residency, refugees and asylees face what amounts to an “indefinite ban on the eligibility” for SNAP and Medicaid, said Matthew Soerens, vice president of advocacy and policy for refugee services nonprofit World Relief, which has offices in Appleton, Eau Claire and Oshkosh.
Food pantries may be many refugees’ and asylees’ best backup when they lose access to SNAP, but advocates say donated food cannot directly replace lost benefits. Milwaukee food bank Hunger Task Force has seen pantry traffic increase by 50% in the past two years, said public policy and advocacy director Reno Wright.
The nonprofit is helping other food pantries prepare for the cutoff, but those programs are “meant to provide supplemental assistance and not long-term ongoing assistance,” Wright said.
What families should know
Mixed-status households should still apply for benefits for the members of their families who still qualify, Wright added. U.S. citizen children of refugee parents, for instance, will remain eligible for nutrition assistance — albeit only for their own needs, not their parents’.
Children who lose access to FoodShare can turn to Milwaukee’s summer meal program, organized by Hunger Task Force and a coalition of school districts and community organizations. The program provides free meals to children ages 18 and under at more than 100 locations in greater Milwaukee.
Alternatives to Medicaid benefits are even harder to find. Free clinics often operate at capacity, Soerens said, and while refugees may still qualify for emergency medical coverage through Medicaid Emergency Services, the program sets a high bar for eligibility and does not cover preventative care or ongoing treatment for chronic conditions.
While some Milwaukee-area clinics are mulling subscription-based alternatives to Medicaid, Mohamed said many of the families his organization supports can’t fit a health care subscription into their budgets.
For now, Lutheran Social Services and its counterparts elsewhere in Wisconsin will rely on donors and community partners to shore up the assistance they provide to refugees and asylees. That need has grown since the Trump administration largely suspended refugee admissions last January, cutting off funding tied to new arrivals and forcing agencies to lay off staff.
But refugee arrivals haven’t ceased entirely. At least 218 refugees have resettled in Wisconsin since last January, all from South Africa.
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Wisconsin’s unemployment rate sits near a historic low, but for thousands of rural residents the link between a layoff and losing health insurance has never been stronger.
Using county-level data from all 72 Wisconsin counties between 2014 and 2023, I tracked how shifts in local unemployment moved together with shifts in the uninsured rate. Before the pandemic, a one percentage point rise in county unemployment was tied to roughly a 0.21 percentage point rise in lack of insurance. After the pandemic, that same increase pushed lack of insurance up by 0.55 percentage points. The relationship more than doubled.
Almost all that vulnerability sits outside our cities.
In Wisconsin’s 46 nonmetropolitan counties, the unemployment-coverage link is strong and statistically significant. In the 26 metropolitan counties, which include the Milwaukee, Madison, Green Bay and Fox Valley metro areas, the same statistical model finds no significant relationship at all.
This is not a story about lazy or careless workers. It is a story about how policy design and geography combine to leave rural Wisconsinites without a net.
Wisconsin made a distinctive choice when the Affordable Care Act became law. The state expanded BadgerCare Plus to adults below 100% of the federal poverty line but declined the full expansion to 138% that most other states have now adopted. The Wisconsinites in that 100% to 138% income band, about $15,650 to $21,597 for a single adult in 2025, are sent to the federal marketplace instead of Medicaid.
Marketplace coverage in that range comes with subsidies, but also with deductibles, co-pays and out-of-pocket maximums that Medicaid would not impose. For a worker who just lost shifts, the marketplace can mean nominal insurance with effective noncoverage. My analysis found that the unemployment-coverage link is sharpest precisely for this low-income group, which is what the policy design predicts.
Rural labor markets compound that policy choice. They have fewer employers, smaller firms and less industry diversification. When a foundry, a paper mill or a dairy processing plant lays off workers, the next job in the same county is unlikely to offer group health benefits. Small firms, which provide a larger share of employment in rural areas than in cities, are far less likely than large ones to offer coverage, a gap documented in KFF’s employer survey.
The supports that help urban workers navigate a coverage transition are also thinner outside the metros. UW-Extension research found that only 63% of households in Wisconsin’s most rural counties had home broadband, compared with over 95% in metropolitan areas.
Healthcare.gov enrollment, marketplace navigator outreach and routine renewal notices all assume reliable internet. A working spouse in a rural area is also less likely to carry employer coverage to fall back on since rural jobs are concentrated in small firms and self employment that often do not offer health benefits.
The pandemic period offers one more piece of evidence. During the public health emergency, federal law required states to keep Medicaid enrollees continuously covered. Coverage held steady even as unemployment surged. The historical link between job loss and insurance loss weakened. Then the Medicaid unwinding began in 2023. Wisconsin disenrolled nearly 394,000 residents from BadgerCare Plus by mid-2024, most for procedural reasons like paperwork rather than actual ineligibility. The post-pandemic coefficient of 0.55 captures what happens when protective policy is withdrawn but the underlying vulnerability remains.
Three state-level actions would directly reduce the harm.
First, complete the BadgerCare Plus expansion to 138% of poverty so that workers in the transition zone are automatically covered when they lose their jobs. A Georgetown University analysis found that full expansion would cover more than 80,000 additional adults in that income band. Assembly Bill 1153, the BadgerCare Public Option introduced this year by Rep. Tara Johnson, D-town of Shelby; Rep. Robyn Vining, D-Wauwatosa, and others, addresses a related gap by letting any Wisconsinite buy into BadgerCare Plus regardless of income and deserves serious debate alongside full expansion.
Second, invest in rural enrollment navigators and renewal pathways that do not assume broadband. Coverage policy without enrollment infrastructure produces coverage on paper only.
Third, build administrative stability into BadgerCare Plus renewals so that procedural disenrollments do not strip coverage from people who remain eligible.
The federal Medicaid cuts enacted in 2025 will widen the rural-urban gap I documented. KFF estimates that the cuts will leave more than 50,000 additional Wisconsinites uninsured by 2034. Without state action, the workers already at the sharp end of the unemployment-coverage relationship will absorb a disproportionate share of that loss.
The link between losing work and losing health security is not a law of economics. It is the result of choices, and Wisconsin can make different ones.
Jiyue Wang lives in New Brunswick, New Jersey. He completed this research as part of his master’s degree in economics at the University of Wisconsin-Milwaukee. He will begin a Ph.D. in political science at Rutgers University in September 2026.
Guest commentaries reflect the views of their authors and are independent of the nonpartisan, in-depth reporting produced by Wisconsin Watch’s newsroom staff. Want to join the Wisconversion? See our guidelines for submissions.
Federal legislation known as the “One Big Beautiful Bill Act” included an estimated $1 trillion in cuts to Medicaid spending over the next decade.
Passed in 2025, the bill included tax cuts and increased spending on immigration enforcement and the military, offset by nearly $1 trillion in cuts to Medicaid, according to the Congressional Budget Office.
Provisions included mandating able-bodied adults to work 80 hours per month to qualify for Medicaid benefits, known as BadgerCare in Wisconsin. That’s estimated to reduce spending by $326 billion through reduced enrollment.
It also freezes provider taxes in states like Wisconsin that have not expanded Medicaid, and it gradually lowers the provider tax rates in expansion states from 6% to 3.5%, saving the federal government $226 billion. States have used taxes on providers such as hospitals to draw federal matching funds.
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