Governor Doyle

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(No Transcript)
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Governor Doyles Health Care Vision

• Every Wisconsin resident has a right to health
  care.
• State government must do what it can to ensure
  that residents have access to high quality,
  affordable care.
• No child should ever be without health insurance.

(more)
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Governor DoylesHealth Care Vision(continued)

• The rising cost of health care is bad for
  Wisconsins economy.
• State government must work with the private
  sector and other stakeholders to find ways to
  control costs.

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Governor Doyles Health Care Policy
Agenda

• BadgerCare Plus all kids covered by health
  insurance
• Healthy Wisconsin re-insurance pool for
  catastrophic care
• Extend MA coverage to childless adults (lt200
  FPL) (NEW)
• Family Care expand statewide
• SeniorCare maintain current waiver

(more)
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Key Health Care Policy Issues

• Increasing numbers of uninsured
• In 2004, 91,000 children (more than 7 of total)
  were without health insurance for at least part
  of the year.
• In 2004, 12, or 10,000, near poor children were
  uninsured for at least part of the year.

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Key Health Care Policy Issues(continued)

• Fewer and fewer businesses are offering their
  employees health insurance.
• In 2001, 76 of Wisconsin residents had their
  insurance coverage provided by their employer.
• In 2004, that number dropped to 69.

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Key Health Care Policy Issues(continued)

• Complex and Costly Eligibility Rules
• Cash assistance vs. health care safety net
• Currently, more than 20 different coverage groups
  in Wisconsin
• Discourages enrollment
• Administrative expense of 800,000 changes that do
  not affect eligibility costs Wisconsin 12.9
  million annually

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BadgerCare Plus

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

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BadgerCare Plus Design

• Five strategic goals
• Cover all kids
• Provide coverage and enhanced benefits for
  pregnant women
• Make the program simple
• Promote prevention and healthy behaviors
• Provide MA access to low-income childless adults
  (NEW! Still in development.)

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BadgerCare Plus Population

• Expansion populations
• Children with incomes above 185 of FPL
• Pregnant women with incomes between 185 and 300
  of FPL
• Parents and caretaker relatives with incomes
  between 185 and 200 of FPL
• Caretaker relatives with incomes between 44 and
  200 of FPL

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BadgerCare Plus Population (continued)

• 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
• Other Childless Adults (lt200 FPL)

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BadgerCare Plus Simplification

• Simplification is a key part of this initiative.
• Simplified gross income test
• Only two deductions
• Student earned income disregard
• Child support payment disregard

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BadgerCare Plus Simplification (continued)

Current Eligibility System
(more)
Medicaid / BadgerCare / Healthy Start
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BadgerCare Plus Simplification (continued)
Proposed Eligibility System


(more)
BadgerCare Plus
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BadgerCare PlusSimplification (continued)

• Presumptive eligibility
• children below 150 of FPL
• pregnant women
• Spenddown for pregnant women to 300 of FPL
• Spenddown for children to 150 of FPL

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BadgerCare Plus Simplification (continued)

• Increase use of web-based applications using
  ACCESS
• Use non-traditional locations to sign up kids and
  pregnant women.
• Health risk assessment tool
• Crowd out provisions

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BadgerCare Plus Benefits

• Two distinct plans
• Standard Plan (current Medicaid benefit package)
  for those with incomes under 200 of FPL
• Benchmark Plan (new) for those with incomes above
  200 of FPL and certain self-employed families

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BadgerCare Plus Benefits (continued)

• 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 (continued)

• Healthy Living Strategies
• Member agreements
• Incentives for HMOs
• Incentives for individuals
• Health literacy/education

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BadgerCare Plus Premiums Cost-Sharing

• Charge premiums to higher income groups (start at
  150 for adults and 200 for children/pregnant
  women.)
• Family premiums capped at 5 of income.
• Standard Plan participants pay nominal copays.
• Benchmark Plan participants pay copays more in
  line with private plans.

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BadgerCare Plus Service Delivery

• Enroll all participants in managed care within
  two years
• Expand HMOs statewide through incentives

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BadgerCare Plus Funding
( million)
SFY 08
SFY 09
Benefit Cost
9.1
37.8
Admin Cost
.8

Total Cost
9.9
37.8
HMO Ex. Savings
17.4
37.6
St. Adm Savings
1.3
2.5
Total Savings
18.6
40.1
NET COSTS
( 8.7 million)
( 2.3 million)
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BadgerCare Plus CMS Discussions

• Discussions began in September 2006.
• Clear message Utilize the DRA!!!!
• We are attempting to get as much accomplished
  through state plan amendment as possible.
• Negotiations have been kept at a staff level
  throughout election season.
• State is in the process of ramping up the
  discussions.

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BadgerCare Plus CMS Discussions

• Areas of contention
• Some cost sharing, especially the premium
  requirement, for pregnant women above 200 of the
  FPL.
• Allowing children, parents, and other adult
  caretaker relatives to be eligible for SCHIP
  funding when they have coverage by insurance,
  even when the employer is paying less than 80 of
  the premium cost for that individual or family.
• 3. The concept of transitional grandfathering
  that would allow adults no longer eligible for
  health care coverage due to changes in policies
  (Family Fiscal Unit, 12 Month Medicaid
  Extensions, etc.) to participate for 18 months.

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BadgerCare Plus For More Information

• Jason A. Helgerson, MPP
• Executive Assistant/Policy Director
• Wisconsin Department of Health and Family
  Services
• 608-267-7284 (phone)
• 608-266-7882 (fax)
• helgeja_at_dhfs.state.wi.us
• http//dhfs.wisconsin.gov/badgercareplus/