Presentation for SCINashville, Tennessee

February 7, 2008

Wisconsin’s

• 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 DesignProgram Design

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

Simplify enrollment and administration

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Four strategic goals:1) Cover all kids2) Provide coverage and enhanced benefits

for pregnant women3) Make the program simple4) Promote prevention and healthy

behaviors

Program DesignProgram Design

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Expansion populations:All children without access to affordable

health insurancePregnant women with incomes no greater

than 300% of FPLParents and caretaker relatives with

incomes below 200% of FPL

BadgerCare Plus – Expansion BadgerCare Plus – Expansion

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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 – Expansion BadgerCare Plus – Expansion

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PregnantWomen

Children 0- 18

ParentsCaretaker Relatives

300%

200%

185%

150%

100%

44%

BadgerCare Plus Expansion

Current BadgerCare

Current Medicaid & Healthy Start

No Income Limit

BadgerCare Plus PopulationCovered Populations

Youth Exiting

Out-of-homeCare

No Income Limit

FPL

Self-Employed/Farmers

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Simplified gross income test Only two deductions

-Student earned income disregard-Child support obligation disregard

BadgerCare Plus – BadgerCare Plus – Streamlining Streamlining Eligibility Eligibility

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Express Enrollment - children below 150% of FPL

- pregnant women Spenddown for pregnant women to

300% of FPLSpenddown for children with

catastrophic health care incidents to 150% of FPL

BadgerCare Plus – BadgerCare Plus – Streamlining Streamlining Eligibility Eligibility

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Increase use of web-based applications using ACCESS

Health risk assessment toolCrowd out provisions

Direct policies Indirect policies

BadgerCare Plus – BadgerCare Plus – Streamlining Streamlining Eligibility Eligibility

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No Employer Verification FormAutomated verification of insurance

coverage and access via employersAnnual renewalBackdating for parents & children under

150% of FPL and all pregnant women

BadgerCare Plus – BadgerCare Plus – Streamlining Streamlining Eligibility Eligibility

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Reduced ReportingAlignment with FoodShare policies

(unearned income, self-employment income, etc.)

Simpler group composition rules (no Family Fiscal Unit)

BadgerCare Plus – BadgerCare Plus – Streamlining Streamlining Eligibility Eligibility

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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 – BadgerCare Plus – Benefit PlansBenefit Plans

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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 – BadgerCare Plus – Benefit PlansBenefit Plans

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PregnantWomen

Children 0-18

ParentsCaretaker Relatives

300%

200%

Medicaid benefit package

Benchmark Plan

Youth Exiting

Out-of-homeCare

BadgerCare Plus Benefits

Benefit PackageNo Income Limit

Self-Employed/Farmers

No Income Limit

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Premium groups:1) Children with incomes > 200% FPL2) Parents and caretakers with incomes

between 150 & 200% of FPL3) Certain self-employed parents with

incomes < 200% of FPL

BadgerCare Plus – BadgerCare Plus – Cost SharingCost Sharing

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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 – BadgerCare Plus – Cost Cost SharingSharing

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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 – BadgerCare Plus – Federal ApprovalFederal Approval

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BadgerCare Plus for Childless Adults

Implementation: January 1, 2009

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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

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• 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

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• 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

BadgerCare Plus for Childless Adults

Questions?

Contact InformationJim Jones, Deputy Administrator

Division of Health Care Access & AccountabilityWisconsin Department of Health and Family Services

jonesjd@dhfs.state.wi.us(608) 266-5312

Fax: (608) 266-6786