The Wisconsin Department of Health Services (DHS) website for enrolling in Medicaid and other state benefits programs. (Screenshot)

Among changes to Medicaid tucked in the federal reconciliation bill that passed the U.S. House last week is one that requires participants in the state-federal health plan for the poor to prove they’re eligible every six months.

Wisconsin advocates said Tuesday the provision is likely to reduce Medicaid enrollment — not because people don’t qualify but because of administrative errors and confusion.

Under current state and federal law, people covered by Medicaid must have their eligibility confirmed every year. Eligibility depends on various factors, chief among them household income. People whose Medicaid services are tied to a disability undergo an annual evaluation to determine whether their disability still qualifies them.

“We already do a really good job about making sure that everybody who’s in Medicaid is already eligible to be there,” Tamara Jackson, policy analyst and legislative liaison for the Wisconsin Board for People with Developmental Disabilities, said in an interview.

Checking eligibility more frequently isn’t likely to uncover more people who are enrolled in Medicaid and don’t qualify, Jackson said: “It will lead to a different result because people who are eligible for the program are losing coverage because they didn’t get the paperwork in on time.”

“It’s going to probably result in kicking people off the program — some of it through error and some of it just benign neglect,” said Bobby Peterson, executive director of ABC for Health. The nonprofit is a public interest law firm that assists people navigating the health care system get coverage and address problems such as medical debt.

“It’s part of a blizzard of paperwork to keep people off the program,” Peterson said of the twice-yearly Medicaid eligibility test. “And it’s not necessarily going to be very effective in maintaining program integrity.”

He said Medicaid participants are already required to report changes in their income that could change whether they’re eligible.  

“It’s calculated to deter people from staying with the [Medicaid] program,” Peterson said. “It’ll leave more people out and less people covered, more people uninsured.”

With fewer people covered by health insurance, that could lead to “higher rates of medical debt, higher rates of uncompensated care, and then the socialization and redistribution of all that medical debt onto everybody else’s [health care] bill,” Peterson said. “So, it’s a lose-lose proposition.”

The House Republican majority drafted the reconciliation legislation in order to extend tax cuts enacted in 2017 during President Donald Trump’s first term.

The bill’s tax cuts largely benefit higher-income households, according to the Congressional Budget Office. The bill’s spending cuts to Medicaid and other programs, including federal nutrition aid, were included to reduce the tax cuts’ impact on the federal deficit.

In Wisconsin, about 1.3 million people are covered by Medicaid, according to the state Department of Health Services (DHS). About 900,000 are enrolled in BadgerCare Plus, which provides primary health care for families and single adults with incomes below the federal poverty guidelines. Another 250,000 are in one of several Medicaid programs for long-term care for people with disabilities or the elderly, and the rest are in other specialized programs.  

The change in how often Medicaid recipients must qualify for the program is just one of many changes in the program under the House reconciliation bill.

In a report produced in late April before the bill’s passage, the state Department of Health Services (DHS) calculated that its proposed Medicaid changes could cost Wisconsin up to $16.8 billion over the next date.

Current federal Medicaid regulations forbid states from determining a person’s eligibility more often than once a year. The House reconciliation bill would effectively override that rule.

A requirement to check every Medicaid recipient’s eligibility twice a year was part of state legislation that Wisconsin Republican lawmakers introduced earlier this year. That bill was met with sweeping criticism at a public hearing in April and has not advanced in the state Legislature.

Supporters of the change have argued that more should be done to reduce fraud in  the Medicaid program. But health care experts contend that the Medicaid cuts in the House bill are unlikely to address genuine fraud.

During the COVID-19 pandemic, the federal government temporarily suspended the annual Medicaid renewal requirement to ensure that people had health coverage and would seek medical help if they felt sick.

“Obviously if there’s a public health emergency, you want to maintain connections and access to health care and coverage,” Peterson said. Some people may have been still covered under Medicaid after they were no longer eligible, he added, and some “didn’t even know they had Medicaid or BadgerCare Plus in addition to some private insurance at various times.”

Nevertheless, “it wasn’t like there was wide-scale fraud” in the Medicaid program, Peterson said. “There’s very little evidence of a lot of consumer-related fraud in the program.”

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Capitol Police remove a protester in a wheelchair from the House Energy And Commerce Committee hearing room during the committee markup of part of the budget reconciliation package on May 13, 2025 in Washington, D.C. (Photo by Jemal Countess/Getty Images for Protect Our Care)

WASHINGTON — The U.S. House committee tasked with overhauling energy policy and Medicaid to achieve $880 billion in spending cuts on Tuesday began what was expected to be a long, grueling session with debate on dozens of amendments.

Republicans on the panel argued during opening statements the proposed changes are necessary to realign several programs with President Donald Trump’s campaign promises and some long-standing GOP policy goals, primarily an extension of the 2017 tax cuts.

Democrats contend the legislation, one of 11 measures that will make up the GOP’s “big, beautiful bill,” would kick millions of people out of Medicaid, the state-federal program for lower income Americans, some people with disabilities and a considerable number of nursing home patients.

Energy and Commerce Committee Chairman Brett Guthrie, R-Ky., said the GOP bill is aimed at reducing waste, fraud and abuse within Medicaid “by beginning to rein in the loopholes, by ensuring states have the flexibility to remove ineligible recipients from their rolls and removing beneficiaries who enrolled in multiple states.”

“We make no apologies for prioritizing Americans in need over illegal immigrants and those who are capable but choose not to work,” Guthrie said. “Our priority remains the same: strengthen and sustain Medicaid for those whom the program was intended to serve — expectant mothers, children, people with disabilities and the elderly.”

Democratic New Jersey Rep. Frank Pallone, ranking member on the panel, rejected comments that the GOP bill was “moderate” and said it clearly was not aimed at addressing waste, fraud and abuse.

“Medicaid is a life-saving program that 80 million Americans count on every day,” Pallone said. “It provides health care to 1 in 3 Americans and nearly half of all children in the United States. It covers close to half of all births. And it’s the largest source of funding for long-term care for seniors and people living with disabilities. With this bill, Republicans are essentially telling millions of Americans, ‘Gotcha, no more health care for you.’”

Pallone added that Republican lawmakers were “intentionally taking health care away from millions of Americans, so they can give giant tax breaks to the ultra-rich, who frankly don’t need them.”

Just before Pallone spoke, several protesters in the room, including at least three people in wheelchairs, began chanting “No cuts to Medicaid” and were led out by U.S. Capitol Police, who charged 25 people with illegally demonstrating in the Rayburn House Office Building.

Photos of constituents

Democrats gave numerous opening statements at the start of the markup, each holding up a large photograph of one of their constituents on Medicaid and sharing stories of how the program helped them get or keep access to health care after complex diagnoses, like congestive heart failure, leukemia and cerebral palsy.

Democratic lawmakers expressed concern those people would lose access to the health care program if the GOP bill becomes law.

“You don’t just gut the largest insurer of low income Americans without real harm,” said Illinois Democratic Rep. Robin Kelly. “Call it what it is — abandonment, disinvestment and pure disregard for human life.”

Florida Republican Rep. Kat Cammack rebuked some of the Democrats’ comments, which she said sought to fearmonger and lie to people about what was in the GOP bill.

“The posters that our colleagues on the left have held up are touching. The stories, they’re very emotional. And I agree that we want to protect those most vulnerable,” Cammack said. “As a pregnant woman, I want to make sure that pregnant women, expectant mothers have access to resources around the country.”

Cammack added that “not a single person in those posters is going to be impacted by this legislation.”

Floor action as soon as next week

Republicans have already approved eight of the reconciliation bills in committee and are scheduled to wrap up work on the remaining three measures this week. The Ways and Means Committee began debating the tax bill shortly after Energy and Commerce began its markup, and the Agriculture panel was scheduled to begin its debate Tuesday evening.

Later this week, the House Budget Committee plans to bundle all 11 bills together and send the full package to the floor. The entire House is set to vote on the legislation before Memorial Day.

GOP leaders cannot afford much disagreement over the entire package, given their paper-thin majority in the House. If all of the current members are present at the vote, just three Republicans can oppose the package and still have it pass.

The same margin exists in the Senate, which is expected to make substantial changes to the package should the House approve the measure and send it across the Capitol.

$880 billion cut

The Energy and Commerce Committee’s bill up for debate Tuesday met the panel’s goal of cutting at least $880 billion in federal spending during the next decade, according to a letter from the nonpartisan Congressional Budget Office.

Congress’ official scorekeepers, however, hadn’t released their full analysis of the panel’s bill before the start of the debate and amendment process, known in Congress as a markup.

Once those details are made public, lawmakers and the voters who elected them will have a much more detailed look at how each of the proposed changes will affect federal revenue, spending and the number of people who could lose access to Medicaid.

Democrats released a CBO analysis last week showing the impact of various proposals, though Energy and Commerce GOP staff cautioned Monday during a background briefing that what they proposed in the actual bill didn’t completely align with those scenarios.

The bill would make considerable changes to Medicaid if the House and Senate approve the legislation as written, which seems highly unlikely, given objections from several GOP senators, including Missouri’s Josh Hawley.

The House legislation would require able-bodied people between the ages of 19 and 65 to work, participate in community service, or attend an education program for at least 80 hours a month. There would be exceptions for pregnant people, Medicaid enrollees with dependent children and people with complex medical issues, among other exclusions.

That provision would take effect on Jan. 1, 2029, according to an explainer on the bill from nonpartisan health research organization KFF.

States would be required to check eligibility for all Medicaid patients every six months, lowering the threshold from one year for people eligible for the program under the expansion in the 2010 Affordable Care Act. That would need to begin by Oct. 1, 2027.

Republicans are seeking to get the 12 states that allow immigrants without legal status into their Medicaid programs to change course by lowering the percent the federal government pays for those states’ expansion population enrollees from 90% to 80%. That would take effect Oct. 1, 2027.

The legislation seeks to block Medicaid funding for a narrow subset of health care providers who offer abortion services, which appeared to target Planned Parenthood.

The prohibition would apply to “providers that are nonprofit organizations, that are essential community providers that are primarily engaged in family planning services or reproductive services, provide for abortions other than for Hyde Amendment exceptions, and which received $1,000,000 or more (to either the provider or the provider’s affiliates) in payments from Medicaid payments in 2024,” according to a summary of the GOP bill. It would take effect as soon as the bill becomes law and last for a decade.

The Hyde Amendment allows federal funding for abortions that are the result of rape, or incest, or that endanger the life of the pregnant patient.

Planned Parenthood, SBA Pro-Life react

Planned Parenthood Action Fund President and CEO Alexis McGill wrote in a statement that defunding the organization and overhauling Medicaid would mean that “cancers will go undetected; it will be harder than ever to get birth control; the nation’s (sexually transmitted infection) crisis will worsen; Planned Parenthood health centers will close, making it significantly harder to get abortion care; and people across the country will suffer — all so the supremely wealthy can become even richer.”

SBA Pro-Life America President Marjorie Dannenfelser applauded the potential change to federal funding.

“It’s time to stop forcing taxpayers to fund the Big Abortion industry. Thanks to Speaker (Mike) Johnson and Energy and Commerce Committee Chairman Brett Guthrie, this year’s budget reconciliation bill contains the commonsense language to make that happen,” Dannenfelser wrote. “Taxpayers should never be mandated to prop up an industry that profits from ending lives and harming women and girls.”

More than 80 organizations, including the National Women’s Law Center and the Center for Reproductive Rights, wrote in a letter to congressional leaders that cutting off Medicaid funding for Planned Parenthood “would be catastrophic, shutting down health centers and stripping millions of patients across the country of access to essential and affordable health care.”

“In many communities, Planned Parenthood health centers are the only affordable provider with expertise in sexual and reproductive health,” the organizations wrote. “For those communities, the gap left by Planned Parenthood health centers would mean that many patients would have nowhere to turn for care.”

President of the American College of Obstetricians and Gynecologists Stella Dantas wrote in a statement the GOP’s changes to Medicaid might create challenges for pregnant patients seeking to access care and that some states may roll back their expansion of postpartum coverage from a full year.

“Pregnant patients who keep their coverage under Medicaid will still face challenges accessing care as labor and delivery unit closures escalate as a result of Medicaid cuts, leaving patients to travel longer distances to give birth,” Dantas wrote. “Ob-gyns are also concerned that the cuts will threaten the 12 months of postpartum coverage that we have fought so hard to achieve, and which will leave so many without access to medical care during the year after delivery when two-thirds of maternal deaths occur.

“Backsliding on our recent progress in increasing access to postpartum coverage puts lives at risk.”

American Public Health Association Executive Director Georges Benjamin wrote in a statement that House Republicans’ planned overhaul of Medicaid “does nothing to improve public health.”

“Instead, it would undermine much of the progress we have made to expand access to affordable, quality health insurance and implement other evidence-based measures to protect the public’s health,” Benjamin wrote. “We urge the House to reject this bill and instead work in a bipartisan manner on legislation to improve public health and expand access to health care for all Americans.”

 

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Major cuts to Medicaid under discussion in Congress would harm patients, the health care system and the economy in Wisconsin, the state health department said in a report Monday, likely increasing health care costs in the long run rather than saving money.

Depending on what route the federal budget takes to reduce spending on the program, it could cost the state up to $16.8 billion over 10 years, according to the report from the Department of Health Services (DHS).

Medicaid — jointly  funded by the federal and state governments — provides health care coverage for low-income Wisconsinites as well as long-term care for elderly people and people with disabilities.

GOP leaders in the U.S. House of Representatives are looking for ways to cut $880 billion from programs under the supervision of the House Energy and Commerce Committee. The budget plan hasn’t taken formal shape. Because Medicaid is the single largest program in the committee’s budget portfolio, however, “substantial impacts to Medicaid and other health programs are unavoidable,” the report states.

In Wisconsin Medicaid covers about 1 million Wisconsin residents up to the age of 65 for primary health care through BadgerCare Plus. It also covers long-term care for people with disabilities and the elderly under a variety of different programs. Medicaid covers 20% of state residents and 40% of births, along with 38% of Wisconsin children and 60% of state residents in nursing homes.

“Medicaid is an important part of our health care infrastructure,” said Wisconsin Medicaid Director Bill Hanna at a DHS press conference Monday.

One possibility the report considers is a cap on federal coverage for each Medicaid patient.

Currently the federal share is 60% of the health care costs incurred by Wisconsin Medicaid recipients, with the state paying the remaining 40%. “This arrangement allows state budgets to cope with unforeseen circumstances, such as economic downturns or faster-than-expected medical cost growth,” the DHS report states.

The report states that a per-person ceiling on Medicaid costs, which Congress is reportedly considering, “would squeeze state budgets and put Wisconsin taxpayers on the hook if medical costs rise quickly, with cuts to benefits and cuts to provider payments.”

Hanna said that there remains “a lot of unknowns” in how Congress might structure a payment system with a ceiling. The report considers various scenarios under a cap, including low, medium and high increases in health care costs.

Over 10 years, Wisconsin could lose anywhere from $6.4 billion to $16.8 billion, DHS projects.

Other Congressional proposals include adding higher barriers to Medicaid coverage — primarily through a work requirement.

Work requirements have long been found to eliminate eligible people from Medicaid because of the additional burden to demonstrate that they are eligible.

“Adding an additional burden for this population will certainly result in fewer people making it through, even if they are working, just struggling with the paperwork pieces,” Hanna said.

According to the report, Wisconsin Medicaid enrolled about 191,000 childless adults per month in late 2024. Nearly half of them would be exempt from a work requirement.

“It is unknown how many people would lose coverage simply because it would be difficult to report their hours or wages,” the report states. It calculates that about 52,000 people “would be at the highest risk for losing eligibility.”

Reducing the Medicaid rolls through a work requirement, however, will carry other costs, the report argues.

“It’s not like these people disappear,” Hanna said.  “They still need care that now they just won’t have the insurance [to cover]. Meaning hospitals again will be picking up additional costs, which gets passed on to all health care consumers.”

A third approach Congress is said to be considering would reduce the federal government’s share of the cost to run Medicaid programs. That could cost Wisconsin up to $93 million, the report finds.

While congressional leaders have pointed to data on “improper payments” in Medicaid in defense of cuts and say they’re targeting “waste, fraud and abuse,” Hanna said members of Congress are  conflating two sharply different issues.

“Improper payments are not fraud, waste and abuse,” Hanna said. “Improper payments are often documentation errors that can be for any number of reasons.”

Wisconsin’s last Medicaid audit — required every three years — found an improper payment rate of 0.5%, which was due to clerical errors.

“In Wisconsin, you’re definitely not going to find significant savings” in the form of ineligible people getting covered, he said. “We have a very robust system in Wisconsin with very few errors.”

Facing substantial federal reductions, the state has four policy options, Hanna said: putting in more state funds to keep the program the same; restricting eligibility, so there are fewer Wisconsinites covered; cutting some services that Medicaid now pays for; or cutting what Medicaid pays to doctors, hospitals and other providers.

If the state pays more, then it will have to raise taxes or divert funds from other priorities. But each of the alternatives has other consequences, Hanna said.

Cutting provider rates “would have major impacts on our state’s health care system,” the DHS report states, with hospitals offsetting those by charging other payers more.

If fewer people are eligible for Medicaid, the rate of uninsured people in Wisconsin will increase, potentially driving up health care costs as well.

“Uninsured rates going up means more uncompensated care” for hospitals and other health care providers, Hanna said.

Reducing the services that Medicaid covers, however, would likely mean that people put off getting health care until an illness or condition gets worse, he said — “which ultimately means we end up spending more.”

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