Tuesday, July 8, 2014

Opportunity to provide input

Opportunity to provide input about

The Department of Health Services (DHS) is holding a public forum
<http://www.dhs.wisconsin.gov/badgercareplus/waivers.htm#forum> to gather
feedback on the recent income eligibility changes made to BadgerCare, which
limit coverage to individuals with incomes at or below 100% of the Federal
Poverty Level, on Thursday, July 10 in Milwaukee. 
As a result of these changes, over 60,000 individuals have lost their BadgerCare coverage as of April 30, and it is now harder for new people, including those with with chronic conditions and mental health needs, to qualify for BadgerCare. Families are encouraged to provide their feedback and comments on how these changes impact health care access for people with disabilities and chronic health needs.
The public hearing will be conducted:

Thursday, July 10
3:00 to 5:00 p.m.

Greater Philadelphia Church of God in Christ
2947 N. Dr. Martin Luther King Drive
Milwaukee, WI 53212

Advocates can also submit their comments via email, fax, or phone. Comments will be accepted through July 30. Gohere <http://www.dhs.wisconsin.gov/badgercareplus/waivers.htm#forum> for more information regarding how to submit your comments via email, fax, or phone. 

The full notice is below: 

*Health Services*

*Wisconsin Department of Health Services*

*(Public Forum Regarding BadgerCare Plus Demonstration Project Waiver)*

The State of Wisconsin reimburses providers for services provided to Medical
Assistance recipients under the
authority of Title XIX of the Social Security Act and Chapter 49 of the
Wisconsin Statutes. This program, administere
by the State’s Department of Health Services (the Department), is called Medical
Assistance (MA) or Medicaid. In
addition, Wisconsin has expanded this program to create BadgerCare Plus program
under the authority of Title XIX and
Title XXI of the Social Security Act and Chapter 49 of the Wisconsin Statutes.
Federal statutes and regulations require
that a state plan be developed that provides the methods and standards for
reimbursement of covered services. A plan
that describes the reimbursement system for the services (methods and standards
for reimbursement) is now in effect.

Section 1115 of the Social Security Act provides the federal Secretary of Health
and Human Services broad authority
to authorize Research & Demonstration Projects, which are experimental, pilot,
or demonstration projects likely to assist
in promoting the objectives of the Medicaid statute. Flexibility under §1115 is
sufficiently broad to allow states to test
substantially new ideas of policy merit. Wisconsin sought and received approval
of a demonstration project waiver from
the Centers for Medicare and Medicaid Services (CMS) under this federal
authority. CMS is an agency within the U.S.

Department of Health and Human Services (DHHS).

The waiver allows Wisconsin to provide health care coverage through BadgerCare
Plus to all childless adults between
ages 19 and 64 and who have incomes that do not exceed 100% of the federal
poverty level (FPL), beginning April 1,
2014. The 2013−15 biennial budget had originally planned for the program changes
to go into effect on January 1, 2014;
however, due to challenges with the federal Health Insurance Marketplace,
Governor Walker and the Wisconsin
Legislature delayed these changes by 90 days to April 1, 2014. For additional
details please see:


The Wisconsin BadgerCare Reform demonstration provides state plan benefits other
than family planning services and
tuberculosis−related services to childless adults who have family incomes up to
95 percent of the Federal Poverty Level
(FPL) (effectively 100 percent of the FPL considering a disregard of 5 percent
of income), and permits the state to charge
premiums to adults who are only eligible for Medicaid through the Transitional
Medical Assistance eligibility group
(hereinafter referred to as “TMA Adults”) with incomes above 133 percent of the
FPL starting from the first day of
enrollment and to TMA Adults from 100−133 percent of the FPL after the first 6
calendar months of TMA coverage.____

The demonstration will allow the state to provide health care coverage for the
childless adult population at or below
an effective income of 100 percent of the FPL with a focus on improving health
outcomes, reducing unnecessary services,
and improving the cost−effectiveness of Medicaid services. Additionally, the
demonstration will enable the state to test
the impact of providing TMA to individuals who are paying a premium that aligns
with the insurance affordability
program in the Marketplace based upon their household income when compared to
the FPL.
__ __

The state’s goals for the program are to demonstrate whether the program will:
Ensure every Wisconsin resident has access to affordable health insurance and
reduce the state’s uninsured rate. Provide a standard set of comprehensive benefits for low income individuals
that will lead to improved healthcare
Create a program that is sustainable so Wisconsin’s healthcare safety net is
available to those who need it most.
__ __

In accordance with federal law, Section 431.420(c) of 42 CFR, the Department
must conduct a public forum within
6 months after the implementation date of a §1115 demonstration project, and
annually thereafter. At the public forum,
the Department is to solicit comments on the progress of the demonstration
project, and allow members of the public the
opportunity to provide comments. The Department is to include a summary of the
forum in the quarterly report to CMS
associated with the quarter in which the forum was held, as well as in its
annual report to CMS.
__ __

This notice serves to meet these federal requirements and to notify the public
that the State of Wisconsin implemented
a new BadgerCare Plus Demonstration Project Waiver on April 1, 2014. The new
BadgerCare Plus Demonstration
Project Waiver replaces two expired waivers: the BadgerCare and BadgerCare Plus
for Childless Adults Section 1115
Demonstrations, as amended by the Medicaid 2014 Demonstration Project Waiver on
July 1, 2012.
__ __

The following public hearing will be conducted:
Thursday, July 10
3:00 to 5:00 p.m.
Greater Philadelphia Church of God in Christ
2947 N. Dr. Martin Luther King Drive
Milwaukee, WI 53212
__ __

Through the BadgerCare Reform waiver, Wisconsin is providing full Medicaid
benefits through the Standard Plan,
including enhanced mental health benefits, substance abuse treatment and
prevention benefits, to all adults in poverty
who were enrolled in Medicaid and BadgerCare Plus. Previously, this level of
coverage had not been available to childless
__ __



DHS is an equal opportunity employer and service provider. If you need
accommodations because of a disability or
need an interpreter or translator, or if you need this material in another
language or in an alternate format, you may request
assistance to participate by contacting Al Matano at (608)267−6848. You must
make your request at least 7 days before
the activity.
__ __


DHS es una agencia que ofrece igualdad en las oportunidades de empleo y
servicios. Si necesita algún tipo de
acomodaciones debido a incapacidad o si necesita un interprete, traductor o esta
información en su propio idioma o en
un formato alterno, usted puede pedir asistencia para participar en los
programas comunicándose con Al Matano al
número (608)267−6848. Debe someter su petición por lo menos 7 días de antes de
la actividad.
__ __


DHS yog ib tus tswv hauj lwm thiab yog ib qhov chaw pab cuam uas muab vaj huam
sib luag rau sawv daws. Yog koj
xav tau kev pab vim muaj mob xiam oob qhab los yog xav tau ib tus neeg pab
txhais lus los yog txhais ntaub ntawv, los
yog koj xav tau cov ntaub ntawv no ua lwm hom lus los yog lwm hom ntawv, koj
yuav tau thov kev pab uas yog hu rau
Al Matano ntawm (608)267−6848. Koj yuav tsum thov qhov kev pab yam tsawg kawg 7
hnub ua ntej qhov hauj lwm
__ __


*Copies of Waiver Documents*

A copy of waiver documents, including the waiver application once complete, may
be obtained from the department
at no charge by downloading the documents from
http://dhs.wisconsin.gov/badgercareplus/waivers.htm or by
__ __

*Regular Mail*

Al Matano
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 53707−0309

Al Matano


Alfred.Matano@dhs.wisconsin.gov <mailto:Alfred.Matano@dhs.wisconsin.gov>


Written comments are welcome and will be accepted through July 30, 2014. Written
comments on the progress of the
waiver to date may be sent by FAX, e−mail, or regular mail to the Division of
Health Care Access and Accountability.
The FAX number is (608) 266−1096. The e−mail address is
<mailto:BCDemonstrationWaiver@dhs.wisconsin.gov>. Comments
can be made on the web site at:

Regular mail can be sent to the above address.
Public comments will be considered to evaluate the progress of the demonstration
project. A summary of the
comments received will be included in the Department’s quarterly report to CMS,
and will be available on the
department’s web site at the address listed above.
__ __

New members can join the list by sending a blank email to join-fan@lists.wisc.edu

Wisconsin Alliance for Women's Health
PO Box 1726 Madison, WI 53701
[p] 608.251.0139 | 866.399.WAWH | [f] 608.256.3004
Be sure to check out our new video that shares our important story!

Wednesday, June 4, 2014

Key Call To Make This Month for Women's Health
The squeaky wheel gets the grease and if you feel strongly about an issue, it's critical to speak up and make a call.  Here's our suggested call this month to make a difference for women's health:
Call Governor Walker &
ask him expand Medicaid!
(608) 266-1212
In the last state budget, the Governor and legislature decided against taking part in the Affordable Care Act's Medicaid Expansion. Instead, the state removed nearly 63,000 parents and caretakers with income over the poverty line from BadgerCare in order to cover nearly 82,000 adults without dependent children with incomes below the poverty line. Medicaid Expansion would have placed the eligibility for all adults at 138% of the poverty level and brought in nearly a half billion dollars in federal funding to the state program through FY 2020 and covered roughly 96,000 more people under BadgerCare than the current budget. The state still has the ability to opt-in to Medicaid Expansion and cover more people with enhanced federal funding at any time in the future.  Call Governor Walker today and let him know you support expanding and strengthening Medicaid in Wisconsin.
For more information:
Where all States Stand on Expansion
Raising the Status of Wisconsin Women's Health
An update from Wisconsin's women's health policy leader

As a Women's Health Advocate, here are the
5 Things to Know for June!
State Leaders Seeking Your Feedback on the Well Woman Program
Last December, the Department of Health Services (DHS) announced proposed changes to the Wisconsin Well Woman Program that were quickly opposed by women's health providers, advocates and patients.  Fortunately DHS has halted their initial proposal and is now welcoming input from the public.  Those interested in weighing in on the future of the program that provides cervical and breast cancer screenings to women in need, should  link here to submit their input.
Nominate a Woman of Courage, Character or Commitment
As we celebrate our 10 Year Anniversary, we look forward to honoring three individuals as outstanding Wisconsin Women's Health Advocacy Leaders at our Fall Anniversary Event.  Award categories reflect the 2014 National Women's History Month theme, "Celebrating Women of Character, Courage and Commitment" Nominations are due by Friday, July 19th and full nomination information can be found by linking here.
Wisconsin Taxpayers Fund Trial for Medically Unnecessary Regulations
Last week, health care experts testified at a trial over Wisconsin Act 37 - a law signed into law by Governor Walker in 2013 that seeks to limit access to abortion.  Unfortunately bills like these are drafted by politicians and not medical experts and now Wisconsin taxpayer dollars are being spent to litigate a law that was opposed by groups like the American Medical Association and American Congress of Obstetricians and Gynecologists. The ruling on this case will made later this summer.
Learn About Our Wisconsin Adolescent Health Care Communication Program 
To ensure healthy future generation, adolescents must be able to engage in open, honest and medically accurate discussions about sensitive health topics with their health care providers.  Yet in reality, providers and teens don't always speak the same language.  This program is an intervention designed to bridge the communication gap between adolescents and their health care providers.  Learn more about this program at:  www.wahccp.org. 

Special Marketplace Enrollment Period Available for Those Eligible 
While the official Open Enrollment Period into the Marketplace is over for 2014, there are special qualifying circumstances like having a baby or getting married that allow you to still apply for health care coverage.  A new screener tool has been developed to help you find out if you qualify to get coverage outside of Open Enrollment.   Link here to find out if you're eligible for this Special Enrollment Period.

Friday, May 16, 2014

NEW COBRA Guidance

Typically, the rules for dropping COBRA are as follows: Yes, you can drop COBRA inside Open Enrollment, get a Marketplace Plan and be eligible for tax credits/subsidies even if your COBRA hasn't expired. No, you can't do the same thing outside of Open Enrollment--if you voluntarily drop COBRA outside of Open Enrollment, you typically are not be eligible for a Special Enrollment Period, so you couldn't get into a Marketplace plan, without a separate qualifying life event. If your COBRA expired outside of Open Enrollment, you WOULD be eligible for a Special Enrollment Period and thus could also be eligible for tax credits/subsidies.
But Wait: New Guidance: HHS will allow current COBRA  enrollees a chance to drop coverage and enroll in a marketplace plan by way of a special enrollment period. The last day to select and enroll in a marketplace plan through this SEP is July 1. Anybody currently in a COBRA plan who wants to switch to a marketplace plan should call 1-800-318-2596 and “inform the Marketplace call center that they are calling about their COBRA benefits and the Marketplace.” Once the person is determined eligible for the SEP, they can either continue enrollment and plan selection over the phone, or use an existing healthcare.gov account, or create a new healthcare.gov account and complete enrollment online.
Video Case Tip: The Penalty Grace Period

Who is eligible for a "grace period" for paying Marketplace Plan premiums? What other criteria need to be fulfilled? How long do you have to pay your premiums before you lose coverage? In this Video Case Tip, we look at the grace period rule.
Click Here or on the picture to the right to watch our Video Case Tip! What problems are you seeing in your area? Send your questions or comments in an email, and we'll create a follow-up webcast filled with the answers!
All our videos are archived in our growing "Video Case Tip Library" so you can visit them at any time.

The Case of the Missing BC+ Numbers


Several weeks ago, the Feds released data about the initial Open Enrollment period for the Federal Marketplace. Now, heads have turned to Wisconsin's Department of Health Services to evaluate their April enrollment data for BadgerCare Plus programs. But there's one problem: the numbers are missing. HealthWatch retained Inspector Clouseau for the case. �� He's looking high and low for the numbers--in office closets and shredding rooms, air vents and bathrooms. But our inspector recognizes that forces within DHS might hold tight to the numbers until no one is looking. For example, we might see the numbers released late in the day on Friday, May 23, just before the long Memorial Day weekend.
In this edition of the Update newsletter, we talk more about BadgerCare Plus as well as more reaction to the first Open Enrollment period in the Marketplace, including comments from Region V Director Falk. Miss the new guidance on coordinating COBRA coverage and ACA coverage? It's in here--under the new term we've coined, "COBRAMACARE!" Not sure about the penalty for not having insurance? It's in this Update's "Video Case Tip."  We also get you caught up on provider memos, Ops Memos, and the new release of the BadgerCare Plus Handbook. There was breaking news today out of the VA--we look at that too. Of course, we bring you case tips and a news round-up, per usual!
Thanks to all of the current members, subscribers, and supporters--you make the HealthWatch Update possible!
HealthWatch members and subscribers, click on the red button below to start reading the full version of this newsletter! Remember to enter your login and password when prompted.
If you are new to the Training Portal, simply click "register" after clicking on the red button above. Answer the questions, create a username and password, and we'll help you take it from there! Not a member? Click here to join HealthWatch Wisconsin!
State Audit of Medicaid Transportation Issues: Share Your MTM Story

The Wisconsin Medicaid Transportation Program and vendor will face a state audit. Auditors are encouraging members of the public to contact them or the Legislative Audit Bureau directly with complaints and other information that they think should be included within the audit.
The Legislative Audit Bureau wants individuals with complaints or experiences with MTM to contact the LAB hotline (1-877-372-8317) to get an accurate picture of the quality of services MTM is providing. The Audit Bureau is online: http://legis.wisconsin.gov/lab/