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

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 Income o 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 Plan Policy & Process Distinctions o 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 Enrollees o 10% were homeless o 59% had no earnings o Monthly Cost (PMPM) = $

BadgerCare Plus Core Plan Enrollees By Gender Male61.6 % Female38.4 % By Age Group Age % Age % Age %

Plans for Wisconsin’s Health Benefit Exchange o 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 Partners o 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.

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