Wisconsin’s Presentation for SCI Nashville, Tennessee February 7, 2008
Overview of BadgerCare Plus • The Federal Approval Process • State Budget Approval • BadgerCare Plus Deployment • BadgerCare Plus for Childless Adults and BadgerConnect
Affordable, comprehensive health care coverage for all children in Wisconsin
Program Design • Create one comprehensive program by consolidating Family Medicaid, BadgerCare (SCHIP), and Healthy Start • Simplify enrollment and administration
Program Design • Four strategic goals: • Cover all kids • Provide coverage and enhanced benefits for pregnant women • Make the program simple • Promote prevention and healthy behaviors
BadgerCare Plus – Expansion • Expansion populations: • All children without access to affordable health insurance • Pregnant women with incomes no greater than 300% of FPL • Parents and caretaker relatives with incomes below 200% of FPL
BadgerCare Plus – Expansion • Expansion Populations(continued): • Youth (ages 18 through 20) aging out of foster care regardless of income • Parents with children in foster care with incomes up to 200% of FPL • Certain self-employed parents & farmers with incomes up to 200% of FPL (depending on depreciation)
BadgerCare Plus Population Covered Populations FPL 300% No Income Limit BadgerCare Plus Expansion Current BadgerCare Current Medicaid & Healthy Start Self-Employed/Farmers 200% No Income Limit 185% 150% 100% 44% Pregnant Women Children 0- 18 Parents Caretaker Relatives Youth Exiting Out-of-home Care
BadgerCare Plus – Streamlining Eligibility • Simplified gross income test • Only two deductions -Student earned income disregard -Child support obligation disregard
BadgerCare Plus – Streamlining Eligibility • Express Enrollment - children below 150% of FPL - pregnant women • Spenddown for pregnant women to 300% of FPL • Spenddown for children with catastrophic health care incidents to 150% of FPL
BadgerCare Plus – Streamlining Eligibility • Increase use of web-based applications using ACCESS • Health risk assessment tool • Crowd out provisions • Direct policies • Indirect policies
BadgerCare Plus – Streamlining Eligibility • No Employer Verification Form • Automated verification of insurance coverage and access via employers • Annual renewal • Backdating for parents & children under 150% of FPL and all pregnant women
BadgerCare Plus – Streamlining Eligibility • Reduced Reporting • Alignment with FoodShare policies (unearned income, self-employment income, etc.) • Simpler group composition rules (no Family Fiscal Unit)
BadgerCare Plus – Benefit Plans • Two distinct plans • Standard Plan = current Medicaid benefit package for those with incomes under 200% of FPL • New Benchmark Plan for those with incomes above 200% of FPL and certain self-employed families
BadgerCare Plus – Benefit Plans • Benchmark plan is based on largest, low-cost, commercial plan • Four benefits added to basic plan • Prescription Drugs • Early Childhood Development Services • Dental Services • Mental Health/AODA
BadgerCare Plus Benefits Benefit Package 300% No Income Limit Benchmark Plan Medicaid benefit package Self-Employed/Farmers 200% No Income Limit Pregnant Women Children 0-18 Parents Caretaker Relatives Youth Exiting Out-of-home Care
BadgerCare Plus – Cost Sharing • Premium groups: • Children with incomes > 200% FPL • Parents and caretakers with incomes between 150 & 200% of FPL • Certain self-employed parents with incomes < 200% of FPL
BadgerCare Plus – Cost Sharing • 5% income cap applied in aggregate, across adults with incomes < 200 % of FPL • Certain farm families—5% of gross income with depreciation included • Enrollees with incomes > 200% of FPL will have co-pays • Restrictive enrollment for failure to pay premiums
BadgerCare Plus – Federal Approval • On 6/30/07, CMS extended the BadgerCare s. 1115(a) Waiver to 3/31/10. • On 11/27/07, CMS approved the SCHIP and Medicaid state plan amendments submitted that provide us with approval for BadgerCare Plus. • CMS has not amended the BadgerCare s. 1115(a) waiver, which would’ve allowed us to claim SCHIP funding for caretaker relatives in the same manner that we do for adults.
BadgerCare Plus for Childless Adults Implementation: January 1, 2009
BadgerCare Plus for Childless Adults • A “childless adult” is any person who is not: • A child under 19 years of age; • Pregnant; • A parent residing with a son/daughter under age 19; • A caretaker relative who resides with and takes care of children under age 19, where the parent is absent; • A person with disabilities; • A person 65 years of age or older; and, • Anyone else who qualifies for full-benefit Medicaid or BadgerCare Plus.
BadgerCare Plus for Childless Adults • The 07-09 Biennial Budget includes authorization to expand BadgerCare Plus to cover childless adults who are uninsured and have income not exceeding 200%. • Their health care plan (BadgerCare Plus Core Plan) will be less generous than the BadgerCare Plus Benchmark Plan and will be delivered through a managed care model, except that mental health services would be provided by the counties. • We expect that 71,000 childless adults will be eligible to enroll in the program. • The program needs to coordinate with the General Assistance Medical Program (GAMP) in Milwaukee, the Family Planning Waiver, the AIDS/HIV program, the Wisconsin Chronic Disease program and the Health Insurance Risk Sharing Plan (HIRSP).
BadgerCare Plus for Childless Adults • Federal approval for this plan is required. • No funding for benefits or administration was included in the budget, but the authority to implement is now in state law. • BadgerCare Plus for Childless Adults will use the same eligibility simplifications that we put in place with BadgerCare Plus. • BadgerChoice • Proactive Identification and Enrollment • Member Services • Centralized Enrollment • Health Needs Assessment • HMO Choice and Automatic Assignment • Employer ‘Buy Up’ to BC+ Core Plus Benefits
Questions? Contact Information Jim Jones, Deputy Administrator Division of Health Care Access & Accountability Wisconsin Department of Health and Family Services email@example.com (608) 266-5312 Fax: (608) 266-6786