Presentation for SCI

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Wisconsins

• Presentation for SCI
• Nashville, Tennessee
• February 7, 2008

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• Overview of BadgerCare Plus
• The Federal Approval Process
• State Budget Approval
• BadgerCare Plus Deployment
• BadgerCare Plus for Childless Adults and
  BadgerConnect

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• Affordable,
• comprehensive
• health care coverage
• for all children in Wisconsin

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Program Design

• Create one comprehensive program by consolidating
  Family Medicaid, BadgerCare (SCHIP), and Healthy
  Start
• Simplify enrollment and administration

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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

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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

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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)

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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
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BadgerCare Plus Streamlining Eligibility

• Simplified gross income test
• Only two deductions
• -Student earned income disregard
• -Child support obligation disregard

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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

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BadgerCare Plus Streamlining Eligibility

• Increase use of web-based applications using
  ACCESS
• Health risk assessment tool
• Crowd out provisions
• Direct policies
• Indirect policies

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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

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BadgerCare Plus Streamlining Eligibility

• Reduced Reporting
• Alignment with FoodShare policies (unearned
  income, self-employment income, etc.)
• Simpler group composition rules (no Family Fiscal
  Unit)

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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

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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

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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
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BadgerCare Plus Cost Sharing

• Premium groups
• Children with incomes gt 200 FPL
• Parents and caretakers with incomes between 150
  200 of FPL
• Certain self-employed parents with incomes lt 200
  of FPL

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BadgerCare Plus Cost Sharing

• 5 income cap applied in aggregate, across adults
  with incomes lt 200 of FPL
• Certain farm families5 of gross income with
  depreciation included
• Enrollees with incomes gt 200 of FPL will have
  co-pays
• Restrictive enrollment for failure to pay premiums

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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 wouldve allowed us to claim SCHIP
  funding for caretaker relatives in the same
  manner that we do for adults.

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BadgerCare Plus for Childless Adults

• Implementation January 1, 2009

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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.

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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).

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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

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Questions?

• Contact Information
• Jim Jones, Deputy Administrator
• Division of Health Care Access Accountability
• Wisconsin Department of Health and Family
  Services
• jonesjd_at_dhfs.state.wi.us
• [phone]
• Fax [phone]