Governor Evers introduced his 2025-27 State Budget on Tuesday night. We are still analyzing the 1,917-page bill.
You can read the Governor’s Budget in Brief here
The Governor’s Executive Budget here
High-level highlights of interest to WRS can be found here:
Department of Health Services
Medicaid Expansion: Accepts federal funding to expand Medicaid (BadgerCare) eligibility from 100% FPL to 138% FPL. This would cover 95,800 low-income individuals and lower state health care costs by $1.9 billion GPR over the biennium.
Health Care Provider Innovation Grants: Provides $7.5 million GPR in the first year of the budget for health care innovation grants, which would help health care providers implement best practices and innovative solutions to increase worker recruitment and retention.
Office of Commissioner of Insurance
Health Insurance Claims Denial Audits: Recommends establishing a framework for auditing high rates of health insurance claims denials among insurers offering plans in the state over which the office has regulatory authority. To improve the coverage of health insurance plans, the office would audit insurers with claims denial rates above a certain percentage, as determined by the office, and require corrective action plans based on the audit findings. The Governor also recommends granting the office the ability to enforce corrective action plans through fines, forfeitures or other mechanisms to ensure compliance within a certain date of receiving the corrective action plan.
Prior Authorization Exemption Requirements: Recommends establishing a framework to streamline and expedite coverage approvals for medical procedures, allowing insured individuals to receive prompt determination regarding coverage for their care. The office would develop parameters for when services are exempt from requiring prior authorization by a health insurer. Providers who receive prior authorization approvals above a certain rate would be exempt from requiring prior authorization for services provided or recommended by them.
Prior Authorization Transparency: Recommends requiring health insurers to provide consumers with a list of treatments and services covered by health plans offered by the health insurer which require prior authorization.
Public Intervenor Office: Provides $1.3 million in the first year of the budget and $1.4 million in the second year of the budget to create a Public Intervenor Office within the office to provide information and assistance to health insurance consumers to ensure they receive the best possible claim outcomes they are entitled to under their insurance policies. Consumers whose health insurance claims are denied would be assisted with appeals and other legal actions to pursue coverage for health care services.
Balance Billing Regulation: Recommends regulating the practice of balance billing, also referred to as surprise billing, in situations where patients have little or no control or knowledge over who provides their care, such as when emergency services are delivered by an out-of-network provider, when ancillary services are delivered at an in network facility by an out-of-network provider or when mental health services are delivered during a crisis. The Governor also recommends that health care providers deliver a good-faith cost estimate of services to the patient before those services are delivered.
Medical Debt Collections Reporting: Recommends prohibiting health care providers, billing administrators and debt collectors working with health care providers from reporting to consumer reporting agencies when medical debt is in collections status without patient disclosure.
Insurer Network Adequacy Standards: Recommends requiring the office to establish standards for insurer networks for all health insurance plans offered in the state. Establishing network adequacy standards would ensure that a covered service is available within a minimum time and distance of the plan holder, improving access to services. The office may also establish further standards that are found to improve access to services, such as maximum wait times for scheduling appointments.
Department of Safety and Professional Services
Statewide Clinician Wellness Program: Provides $800,000 per year for the establishment of a statewide clinician wellness program to support health care providers.
Advanced Practice Registered Nursing: Recommends establishing a new system of licensure that allows registered nurses to be licensed by the Board of Nursing as advanced practice nurse practitioners, giving the advanced practice nurse practitioners a greater scope of practice, such as issuing prescription orders and delegating certain tasks to other clinically trained health care workers.
Physician Title Protection: Prohibits a person who is not licensed as a physician from using physician-related titles like radiologist.
Licensing Mobility and Interstate Healthcare Workforce: Provides 3.0 positions and expenditure authority to enhance licensure opportunity in Wisconsin through health-related multistate compacts and reciprocity agreements.
Credentialing: Provides an additional $875,500 per year and 10 positions to ensure efficient and effective processing of license and credential applications, which will improve the customer experience and ensure the safety and economic well-being of Wisconsin residents.
Customer Communication: Provides an additional $956,400 in the first year and $1 million and an additional 14 positions to meet public demand for licensed occupation assistance.
