Wisconsin payer mix, regulation & malpractice drivers
- Surprise billing protection: Moderate state statute — partial state-level surprise billing protection alongside federal NSA
- Certificate of Need (CON) status: Extensive Certificate of Need — broad CON program covering hospitals, ASCs, imaging, and surgical capacity
- Medicaid expansion status: Partial Medicaid waiver — coverage to 100% FPL but not full ACA expansion
- Malpractice non-economic damages cap: Hard statutory non-economic damages cap — $750K non-economic cap under Wis. Stat. § 893.55 (UPHELD by Wisconsin Supreme Court 2018 in Mayo v. Wisconsin Injured Patients and Families Compensation Fund)
- Hospital price transparency mandate: Federal CMS Hospital Price Transparency Rule (45 CFR Part 180) only — no state-level supplement
- Dominant health insurance market structure: Regional-system dominant — vertically-integrated regional health system shapes market
Wisconsin medical board & physician licensing
- License status: Statewide license required
- License board: Wisconsin Medical Examining Board — Wisconsin Department of Safety and Professional Services (DSPS) (official site)
- Permit: Wisconsin Medical Examining Board MD/DO license required; DEA Schedule II-V + Wisconsin Prescription Drug Monitoring Program (WPDMP); hospital privileging at Aurora Health Care / Advocate Aurora (now Advocate Health) / Froedtert Health / UW Health / Marshfield Clinic / SSM Health Wisconsin / ProHealth Care; CON required under Wisconsin Department of Health Services (DHS) Division of Quality Assurance; BadgerCare Plus partial Medicaid waiver
How medical care costs vary in Wisconsin
State-specific code or insurance rule: Wisconsin operates a unique partial Medicaid expansion under the BadgerCare Plus Section 1115 waiver — covering childless adults up to 100% of federal poverty level (FPL) but NOT the full ACA expansion population to 138% FPL — making Wisconsin one of the 9 ACA-Medicaid-expansion-holdout states with respect to full expansion, though Wisconsin's partial coverage to 100% FPL is more generous than the other 8 holdout states (AL, FL, GA, KS, MS, SC, TN, TX), and Wisconsin Supreme Court UPHELD the state's $750,000 medical malpractice non-economic damages cap in Mayo v. Wisconsin Injured Patients and Families Compensation Fund (2018) under Wis. Stat. § 893.55 — making Wisconsin one of the few hard-cap states with the cap recently judicially upheld.
Cities in Wisconsin
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