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“Do you abuse more than one drug at a time?”: Wisconsin to drug screen people on Medicaid

Here are the drug questions poor residents will have to answer to keep health care.

WEST BEND, WI - AUGUST 16: Wisconsin Gov. Scott Walker introduces Republican Presidential Candidate Donald Trump as he gets ready to speak at a rally on August 16, 2016 in West Bend, Wisconsin. (Photo by Darren Hauck/Getty Images)
WEST BEND, WI - AUGUST 16: Wisconsin Gov. Scott Walker introduces Republican Presidential Candidate Donald Trump as he gets ready to speak at a rally on August 16, 2016 in West Bend, Wisconsin. (Photo by Darren Hauck/Getty Images)

In addition to imposing 80 hours of work per month, Wisconsin will require that Medicaid recipients complete a drug screening questionnaire to keep their health coverage.

While the Trump administration rejected Wisconsin’s bid to drug test Medicaid recipients, the Department of Health Services (DHS) told ThinkProgress on Friday that the state will ask them the same questions they already ask people on cash assistance as a condition of eligibility. The “Drug Abuse Screening Test” is a 10-part questionnaire that asks point blank “Do you abuse more than one drug at a time?”

The screener in this context has been described by some experts as pointless at best and offensive at worst.

The Trump administration approved a host of changes to Wisconsin’s Medicaid program on Wednesday, adding work requirements, premiums, co-payments, and drug screenings. The state did not expand Medicaid under the Affordable Care Act, meaning the new restrictions affect people making up to 100 percent of the federal poverty or about $12,000 annually for a single person. 

Three other expansion-states (Kentucky, Arkansas, and New Hampshire) already received federal approval to add work requirements to the federal health care program, which for the most part serves low-income people. Wisconsin, however, is the first state to get the okay to drug screen Medicaid recipients, who will have to answer questions about their possible drug history during a “health risk assessment.”

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“DHS is working on developing the health risk assessment that will ask questions about healthy behaviors. Questions from the Drug Abuse Screening Test (DAST-10) will be included in the assessment,” DHS Communication Specialist, Jennifer Miller, told ThinkProgress by email. 

During this assessment, the state will also ask recipients about “excessive alcohol consumption, failure to engage in dietary, exercise, and other lifestyle . . . behaviors in attempt to attain or maintain a healthy body weight, illicit drug use, failure to use a seat belt, and tobacco use,” according to Wisconsin’s approved application. Depending on responses, beneficiaries can be charged an additional $4 for “unhealthy” behaviors.

The answers to the drug questions shouldn’t impact eligibility. A person, however, could be referred to addiction treatment.

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Even though the Trump administration framed the health risk assessment as a compromise that was a step removed from testing Medicaid beneficiaries outright, experts say asking about drug use could lead to a decline in enrollment.

“We know from similar drug screening policies in other basic assistance programs that asking questions about substance use can deter people with substance abuse disorders from enrolling – which in this case, could prevent them from receiving treatment as well as other needed care,” Center on Budget and Policy Priorities senior policy analyst Hannah Katch said in a statement to ThinkProgress by email.

“While completing a health risk assessment can be helpful to health care providers managing health, taking coverage away from people who have concerns about providing sensitive and private information to the state conflicts with Medicaid’s purpose of providing coverage.”

The available data suggests that the assumption that people on public assistance misuse drugs a lot more than the general population is incorrect:  A federal analysis on substance use among government assistance enrollees shows drug misuse rates that are only slightly higher than for the general public.

Of 3,799 Wisconsin residents on cash assistance who fulfilled this 10-part questionnaire between July 2016 and February 2018, 83 people were referred for drug testing and only 12 failed. Only 10 people ultimately enrolled in treatment.