On Oct. 31, the Centers for Medicare & Medicaid Services (CMS) approved Wisconsin’s 1115 Medicaid waiver request to allow the state to implement work requirements for its Medicaid population. Wisconsin’s request is the fifth to be approved by CMS and, similar to policies approved for other states, will require childless adults between the ages of 19 and 49 who are not eligible for specified exemptions to work, volunteer or participate in school or job training for at least 80 hours a month to maintain Medicaid eligibility.

While some experts have expressed concern about disenrollment, Wisconsin’s rules for disenrollment are less strict than those approved for other states. Arkansas, the only state to implement a work requirement to date, requires disenrollment after three months of noncompliance. So far, the state has disenrolled 8,000 individuals since implementation in June. Wisconsin’s proposal, on the other hand, limits individuals to 48 months of coverage before a six-month period of mandatory disenrollment begins. Any month where the requirement is met, however, does not count toward the 48-month lifetime cap.

The waiver also allows the state to begin charging monthly premiums to childless adults with incomes between 51% and 100% of the federal poverty level and implement an $8 copayment for all emergency room visits. Under the waiver, the state will charge these individuals $8 per month, which may be reduced by half for engaging in “healthy behaviors” as defined under the waiver. Five other states currently charge similar premiums for Medicaid recipients, while 22 have implemented some type of cost-sharing requirement for provider treatment. CMS did not approve a more controversial request from the state to begin drug testing recipients as a condition of eligibility.

Following Tuesday’s election, it is unclear if Wisconsin will implement the requirements. The waiver proposal was produced by the office of Governor Paul Walker, but Governor-elect Tony Evers does not support the requirements. Governor-elect Evers will have the authority to modify or pull the waiver.

The other states with approved waivers are Arkansas, Indiana, Kentucky and New Hampshire. New Hampshire is expected to implement its work requirement in January. Kentucky’s approved requirement was overturned by a federal judge, but a revised waiver request is currently being reviewed by CMS. Although Arkansas has implemented its requirement, a lawsuit challenging its legality has been filed in federal court.