Wisconsin’s Experience with BadgerCare Plus Enrollment and Implications for Reform Implementation...
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Wisconsin’s Experience with BadgerCare Plus Enrollment and Implications for Reform Implementation National Academy for State Health Policy Conference October 5, 2010 New Orleans, Louisiana James D. Jones Deputy Medicaid Director & SNAP Director Division of Health Care Access & Accountability Wisconsin Department of Health Services
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Transcript of Wisconsin’s Experience with BadgerCare Plus Enrollment and Implications for Reform Implementation...
Wisconsin’s Experience with BadgerCare Plus Enrollment and
Implications for Reform Implementation
National Academy for State Health Policy ConferenceOctober 5, 2010
New Orleans, Louisiana
James D. JonesDeputy Medicaid Director & SNAP Director
Division of Health Care Access & AccountabilityWisconsin Department of Health Services
Overview
o Brief History of BadgerCare Plus and the Gross Income Transition Experience
o Adults Without Dependent Children (Childless Adults) Experience (no mandate)
o Post Health Care Reform Eligibility Process Ideas
BadgerCare Plus & the Gross Income Test
What is BadgerCare Plus?o In 1999, Wisconsin implemented BadgerCare
Health care for children, pregnant women and parents up to 200% of the Federal Poverty Level
Medicaid (Title 19 of the Social Security Act) and the State Children’s Health Insurance Program (SCHIP – Title 21 of the SSA) – Demonstration ‘Waiver’
o In 2008, Wisconsin implemented BadgerCare Plus Standard and Benchmark Plans Health care access for ALL uninsured children, pregnant women up to
300% FPL and parents/caretakers up to 200% FPL. Two plans
Standard – Medicaid benefits for those up to 200% FPL Benchmark – Closely resembles most commonly sold health insurance plan
Streamlined and consolidated the enrollment rules and process. Medicaid and SCHIP
What is BadgerCare Plus? o In 2009, Wisconsin implemented BadgerCare Plus Core Plan
Health care access for uninsured adults without dependent children with incomes up to 200% FPL.
Enrolled the General Assistance/Relief Medical Program participants in Milwaukee and other counties
Core Plan is a narrower group of benefits than the Benchmark Plan. Medicaid Demonstration Project Waiver Capped by federal budget neutrality amount
o In 2010, Wisconsin implemented BadgerCare Plus Basic Plan Self-funded insurance product (no federal or state funding) Health care access for those on the Core Plan waiting list $130/month premium Basic Plan benefit plan is narrower than the Core Plan Not Medicaid or SCHIP
Goals for Streamlining
o Keep it simple for the member and the worker to understand, enroll and stay enrolled in a health care program.
o Eliminate the distinctions between ‘subprograms’ (1931, poverty level for pregnant women and children, CHIP, etc.)
"Pay no attention to that man behind the curtain."
Transition to Gross Incomeo Wisconsin uses a gross income test for BadgerCare
Plus.
o To comply with federal rules for the family program, Wisconsin maximized the amount of each disregard and deduction and moved that calculation into the income test side of the equation. OLD: Income minus disregards/deductions vs.
Income Limit NEW: Income vs. Income Limit (with maximized
deductions and disregards)
Gross Income Transition Results o Unexpectedly added 42,000 children and parents
when we converted from BadgerCare to BadgerCare Plus.
o Reduced time for applications by 10 minutes and renewals by 5 minutes.
o Simplified eligibility systems and policy for workers and members.
BadgerCare Plus Core PlanPolicy & Process Distinctionso Health Needs
Required a Health Needs Assessment (passed that information to HMO)
Required a physical exam in first year Transitioned General Assistance Medical Program
members and reviewed their claims data from that program’s Third Party Administrator (passed info to HMO)
o ACCESS/Phone Required use of ACCESS ONLINE SCREENING AND
APPLICATION TOOL or telephone to apply/renew Implemented Telephonic Signature Applications (82% ACCESS / 18% Telephone)
o Community Access Points
BadgerCare Plus Core Plan Enrolleeso 10% were homeless
o 59% had no earnings
o Monthly Cost (PMPM) = $286.10
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BadgerCare Plus Core Plan Enrollees
By GenderMale 61.6 %Female 38.4 %
By Age GroupAge 19-34 31.4 %Age 35-44 14.5 %Age 45-64 54.1 %
Plans for Wisconsin’s Health Benefit Exchangeo One Front Door (small group, non-group, MA/CHIP).o Leverage ACCESS (public facing web site) and CARES
(eligibility system).o Separate intelligent driver flows for employers,
employees, individuals/families and health plans. [IS THIS INTEGRATED ACQUISITION OF PROOF?]
o Customer friendly Use of data exchanges to gather information (household
members, income, etc.) to limit amount of information the customer has to enter.
Immediate, automatic determination of premium tax credit, reduced cost sharing, and MA/CHIP eligibility.
Guided choice of health plans. Payment options (on-line, mail, phone) Communication options
o Vertically and Horizontally Integrated (FS, TANF, CC)
Amount Subsidized Will Appear in Exchange to
Customer
Federal Data
Trusted Third Party
Data
Individual Enters Basic HH Info into the Exchange
Exchange pulls in data from Third Party Sources
No? Then ask more questions
and request verification
Is information correct & complete?
ACCESS automatically determines subsidy amounts
(tax credit, reduced cost sharing & Medicaid)
Yes? Go To NEXT STEP
Determination of FoodShare and TANF
Eligibility, if requested or if appropriate
Counties & Community Partnerso Wisconsin County Administered/State Supervised
(until 2010).o 2010 – nearly 50% of cases handled by State
Enrollment Services Center (ESC) – Childless Adult Population
Milwaukee Enrollment Services (MilES)o BadgerCare Plus Relied (and relies) Heavily on
Community Access Points (especially in Milwaukee).
o ACCESS / CARES / Electronic Case File all on the web.
Possible Future
o Status Quo Model (County/ESC/MilES).
o MilES Model (State Managers / County Workers) with Central Call/Change Center.
o ESC Model (State Managers / State Workers) with Counties acting as additional Community Access Points.
Possible Future
o HEAVY Reliance on Community Partners & Community Access Points (needed statewide).
o Reliance on Brokers’ Experience and Relationships with Small Employers for SHOP Exchange.
