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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

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presentation for sci nashville tennessee february 7 2008

Wisconsin’s

Presentation for SCI

Nashville, Tennessee

February 7, 2008

slide2

Overview of BadgerCare Plus

  • The Federal Approval Process
  • State Budget Approval
  • BadgerCare Plus Deployment
  • BadgerCare Plus for Childless Adults and BadgerConnect
slide3
Affordable,

comprehensive

health care coverage

for all children in Wisconsin

program design
Program Design
  • Create one comprehensive program by consolidating Family Medicaid, BadgerCare (SCHIP), and Healthy Start
  • Simplify enrollment and administration
program design5
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
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 expansion7
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)
slide8

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
BadgerCare Plus – Streamlining Eligibility
  • Simplified gross income test
    • Only two deductions

-Student earned income disregard

-Child support obligation disregard

badgercare plus streamlining eligibility10
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 eligibility11
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 eligibility12
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 eligibility13
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
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 plans15
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
slide16

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
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 sharing18
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
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

BadgerCare Plus for Childless Adults

Implementation: January 1, 2009

slide21

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.
slide22

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).
slide23

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

Questions?

Contact Information

Jim Jones, Deputy Administrator

Division of Health Care Access & Accountability

Wisconsin Department of Health and Family Services

jonesjd@dhfs.state.wi.us

(608) 266-5312

Fax: (608) 266-6786