Keeping the safety net in reach for Wisconsinites facing new Medicaid rules.

The Challenge

In early 2020, a policy change to Wisconsin's public health care coverage (BadgerCare+) would require residents to take new actions to keep their eligibility — completing a required questionnaire and paying a small monthly premium. If Wisconsinites took no action, they would lose coverage. The Department of Public Health planned to roll the new requirements out through its MyACCESS self-service app, and had prototypes ready to test.

The engagement came with real constraints: an eight-week timeline, a scope initially focused narrowly on interface testing, and — at the outset — no citizens in the research plan at all. We used prior case study evidence to make the case that front-end changes have downstream human impacts, and brought end users into scope.

What We Did

We structured the work as two 30-day sprints pairing evaluative and generative methods. In Wisconsin Rapids, we ran a discovery forum with DPH case workers and a group interview with rural residents. In Madison and Milwaukee, we conducted ethnographic interviews with urban and ESL Wisconsinites and the community assisters who help them navigate benefits — five distinct personas in all, with DPH case workers and staff participating directly in research activities.

Alongside the ethnography, we usability-tested the three critical MyACCESS flows the policy depended on: premium payment, the required questionnaire, and the optional health survey — pairing every screen-level evaluation with the context of participants' day-to-day lives with BadgerCare+.

What We Learned

The proposed UX performed well in testing — task success rates above 90%. But the ethnographic context revealed pitfalls no lab test would catch. Many participants were underbanked and transacted mostly in cash, with no way to act on a digital-only payment flow. Complex policy language made it hard to understand that a missed payment or unanswered questionnaire could cost them their coverage. And the moments that mattered most — like the questionnaire confirmation — offered no supportive resources to the people the policy was designed to help.

What Changed

We facilitated three concept design workshops — ideation, refinement, and prioritization — grounded in Wisconsinite-centered design principles. The results drove immediate change: underbanked residents got clear information for paying by cash or check, plain-language standards improved comprehension of eligibility requirements, and a Resource Page feature was prioritized to connect residents to substance-abuse treatment and healthy-behavior resources at the moments they needed them.