Know Your Legal Rights is a bi-monthly column distributed by the State Bar of Wisconsin. It is sponsored by the State Bar of Wisconsin’s Lawyer Referral Service (LRS), which connects Wisconsin residents with lawyers throughout the state. To find an attorney in your area, visit wislaw.org.
By Atty. Bobby Peterson
New federal work requirements will affect some Wisconsin adults enrolled in BadgerCare Plus beginning in 2027. The rules are complex. However, those members can take steps now to lower their risk of losing coverage because of missed notices or paperwork.
Who may be affected?
The requirements generally apply to the BadgerCare Plus “childless adult” members ages 19 through 64, without dependent children in the home. However, many members will be exempt. They may include:
- People enrolled in another Medicaid program
- Adults who live with a dependent child under age 19 at least 40% of the time
- People who are pregnant or were pregnant within the past 12 months
- People who have been found to have a disability
Other exemptions may apply to:
- People with serious medical conditions*
- Certain caregivers and veterans
- People receiving treatment for drug or alcohol use
- Certain current or former inmates
- Former foster youth
- Tribal members
- People who meet Wisconsin Works requirements
*Some states, including Wisconsin, are currently litigating the requirement to prove serious or chronic medical diagnoses (“medical frailty”) to secure an exemption.
Wisconsin also plans to allow short-term exemptions for certain hardships. These may include a hospital stay, certain disasters or high unemployment in a person’s area.
People who are homeless, however, do need to follow work rules unless they fit another exemption. BadgerCare Plus applicants and members generally must prove they qualify for an exemption if the state’s internal data reviews cannot automatically verify it.
How can someone meet the requirement?
A person who is not exempt may meet the requirement through one or more approved activities. These may include working, volunteering, taking part in an approved work program or attending school at least half time.
A person may combine activities to reach 80 hours in a month. A person may also qualify by earning at least $580 per month in 2026. That equals 80 hours of work at the federal minimum wage. The required amount may change in future years.
Under Wisconsin’s current plan, members will not have to prove each month that they meet the requirement.
Starting Jan. 1, 2027, a new applicant generally must show that the requirement was met during the month before applying. The person may instead show that an exemption applied.
For most current members, the first check will take place at their scheduled renewal beginning in March 2027. Wisconsin plans to check whether the member met the requirement or qualified for an exemption during at least one month since the member’s last approval.
What should members do now?
First, make sure the state can reach you. Give the state your current mailing address, phone number and email address.
- Create an account at ACCESS.wi.gov. You can also download the free MyACCESS Wisconsin app from the App Store or Google Play. Choose online notices if that option works for you.
- Read every letter or notice about your coverage. The state expects the first round of letters to be sent in August/September.
- Start tracking and keeping proof of your monthly income, work, volunteer, or school hours. Records may include pay stubs, bank statements, work schedules, or school records.
- Gather records you might need to prove an exemption. Records may include pay stubs, work schedules, school records, or medical documents.
If the state cannot confirm that you met the rules, it generally must send you a notice. You will have 30 days to provide more information.
Do not ignore the notice. Contact the agency named in the letter as soon as possible. If your coverage is denied or ended and you believe the decision is wrong, review the appeal instructions and deadline. You may ask for a fair hearing.
A person who loses BadgerCare Plus for not meeting the requirement may apply again at any time. However, federal law generally prevents that person from receiving advance tax credits to help pay for Marketplace coverage. That makes it especially important to respond quickly.
Where Can BadgerCare Plus members get help?
- Need help with an application or renewal? Contact your local county human services agency.
- For Advocacy or BadgerCare Plus navigation assistance, schedule an appointment online at coveringwi.org/enroll or call (877) 942-6837.
- Medicaid: New Federal Work Requirement | Wisconsin Department of Health Services: bit.ly/4xREsJp
- For current BadgerCare Plus work-requirement information and resources, scan the QR code or visit bit.ly/4xREsJp.
Attorney Bobby Peterson is the founder and executive director of ABC for Health and My Coverage Plan, organizations that help families access and maximize health care coverage. A 1987 graduate of the University of Wisconsin Law School, he has extensive experience advocating for clients facing health insurance denials and other barriers to health care benefits.
Know Your Legal Rights is sponsored by the State Bar of Wisconsin’s Lawyer Referral Service, which helps connect the public with appropriate legal counsel. Learn more at wislaw.org.
This column provides general legal information, not legal advice. Laws may change. Consult an attorney about your specific situation.
