University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

Getting Parents Enrolled in Medicaid: Lessons from

Wisconsin‘s BadgerCare Plus Auto-Enrollment Process

Thomas DeLeireLindsey Leininger, Laura Dague, Shannon Mok,

Donna FriedsamUniversity of Wisconsin-Madison

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

Health Care Reform• A key coverage component of the law is an

expansion of Medicaid to 133% FPL– CBO estimates that roughly 50% of the increase

in coverage will come from Medicaid expansion

• Low-income parents represent an appreciable portion of the newly eligible population– 4.1 million or 34% of newly eligible adults

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

Enrollment of Eligible Persons• Many eligible individuals do not enroll in

Medicaid– 75% of uninsured children and 28% of

uninsured parents are eligible for public insurance (Holahan et al., 2007)

• Getting uninsured individuals enrolled quickly may be important for improving health (McWilliams et al., 2009)

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

Auto-Enrollment Should be Considered for Health Reform Implementation

• Outline– Wisconsin’s experience with auto-enrollment– National and state by state estimates of the

number of parents that could be auto-enrolled

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

The Launch of • WI’s BadgerCare+ : joint Medicaid & CHIP

program

• Massive reform effort launched in Feb. 2008• Eligibility expansion• Auto-enrollment• Simplification of enrollment and recertification

processes• Aggressive marketing campaign

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

Auto-Enrollment in Wisconsin• WI implemented a one-time “auto-

conversion” effort immediately prior to BC+ program launch – Auto-enrolled 44,000 previously ineligible or

pending applicants • Applied new program eligibility criteria to

previously ineligible individuals for whom there was current administrative data

• 92% of were siblings and/or parents of existing beneficiaries

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

Auto-Enrollment in Wisconsin• Anyone who had a family member enrolled

in state health programs in December 2007 or January 2008), or who had had a case closed 30 days prior were auto-enrolled

• 44,000 auto-enrollees out of almost 70,000 individuals newly enrolled in the first month

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

Kaplan-Meier Estimates of Disenrollment by Auto-Enrollment

0.0

00

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0.5

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.75

1.0

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ike

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od

of

dis

en

rollm

en

t

0 5 10 15 20M o nths s in ce enro lled

O the r F eb rua ry e nro llee s A utoe nro llee s

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

Auto-Converts vs. Other New February 2008 Entrants

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

Auto-Enrollment Potentially Useful In Federal Reform

•American Community Survey, 2008

•Calculate the number of parents who would become newly eligible under 133% FPL eligibility

•Calculate what fraction of these have children already on public insurance

•Calculate what fraction of these are currently uninsured

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

LEGEND

Not Applicable

23% (min) to 45%

45% to 60%

60% to 78% (max)

Percent of Newly Eligible Parents Who Are Potential Auto-Enrollees

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

Percent of Potential Auto-Enrollees with Private Health Insurance

LEGEND

Not Applicable

14% (min) to 25%

25% to 35%

35% to 41%(max)

University of Wisconsin

POPULATION HEALTH INSTITUTE

Translating Research into Policy and Practice

Conclusion• Auto-enrollment of parents

– Should be feasible given many existing data systems

– Has the potential to enroll 2.3 million parents immediately upon program expansion

– Is target efficient as 75% of these parents are uninsured