Monday, September 15, 2014

Getting Ready for Surgery

I have a CT scan scheduled for the end of the month and two doctors visits will follow, one doctor to do the major surgery called debalking and the other will do the hernia surgery. My primer doctor called in a specialist because the hernia is surounded by the mucinous tumors, it will require skilled hands to perform both surgeries. Thankfully and blessedly both doctors are just that.

I have been busy getting all of my affairs in order such as the DPA, medical directives, funeral arrangements (just in case) getting the house cleaned and ready for me to come home and recuperate, it's amazing how much needs to be done and how much there is to prepare for, for such an event. My goal was to make as money as possible this summer at the market so my children can pay the bills and have a cushion for unexpected expenses, but that didn't happen, I was sick twice, injured once all while taking care of my aged mother, two children with health problems, a sick dog, a neighbor that caused us problems and trying to make some money. Whew! Despite all of that, I was able to spend time with friends and family and now I have a whole bunch of wonderful memories to recall while I am recuperating.

I have no doubts or fear over this upcoming surgery, I am in the best possible hands and I have my fathers strong will to survive, there is still so much to do and I plan on being around to do it!
Good News for BadgerCare Plus Enrollees Terminated last April 1
The Centers for Medicare and Medicaid Services (CMS) announced that it is offering a Special Enrollment Period (SEP) to those who lost BadgerCare Plus and have not yet made their way into the Health Reform’s Marketplace. Spread the word!
The new SEP runs: September 4 – November 2
What you need to know
  • Coverage start dates are based on when individuals apply. Apply and enroll between the 1st and the 15th of the month, coverage starts on the 1st of the subsequent month.
  • The SEP is effective through 2014.
  • Those who lost BC+ on or before April 1 are eligible to apply
  • To apply, CALL the Marketplace at 1-800-318-2596 (do not go online).
  • Magic words when calling: I’m from Wisconsin; I lost BadgerCare Plus; I’d like to enroll in a Special Enrollment Period.
The announcement came less than a week after Senator Tammy Baldwin, D-Wis., wrote a letter to CMS urging them to grant a special enrollment period for the individuals who lost Medicaid coverage. Parents and adults who were effected lost coverage because the State’s decision to change eligibility for the program.
As of April 1, 2014 parents enrolled in BadgerCare Plus and adults enrolled in the Core Plan, who were previously covered up to 200% of the federal poverty level, then had to meet the new standard of 100% FPL. This resulted in nearly 63,000 individuals losing coverage. Of that, 38,000 adults did not make it through the eligibility corn maze and into the Marketplace. The SEP became effective September 4th and runs through November 2nd.
Action Steps to Enroll
To enroll, a consumer must call in the Marketplace Call Center to request the special enrollment period. The consumer will receive coverage a month after submitting their application, and will maintain that coverage through 2014. Consumers may automatically enroll into the same plan for 2015, but consider the opportunity to review emerging new Marketplace plan and price options for the intent of this special enrollment period is to get those who lost BadgerCare Plus covered and minimize the health coverage gap. See more on the new SEP below!
In this issue we update you on ABC for Health's 20th Anniversary, auto enrollment in the Marketplace, the upcoming changes to Express Enrollment, and more! We also get you caught up on Provider Memos, Ops Memos and showcase some great articles from the past two weeks. Of course, we bring you case tips and a news round-up, per usual!

Wednesday, September 10, 2014

Call Wisconsin Senators Tammy Baldwin (202) 224-5653 & Ron Johnson (202) 224-5323 to Ask Them to Vote to Support the Paycheck Fairness Act 
Women - on average - earn 77 cents for every dollar a man makes.  The Paycheck Fairness Act helps women fight the wage gap by requiring greater transparency from employers - who would have to show that wage differences are job-related and not gender-based - and protects employees from retaliation when they share information about compensation.  This vote is expected to take place in the US Senate this week.  Make a call today to one or both of Wisconsin's Senators and ask them to support the equal pay for equal work and to support the Paycheck Fairness Act.

For more information:
New National Suicide Prevention Lifeline Toolkit
September marks National Suicide Prevention Month.   Women attempt suicide more often durng their lives than do men and women report higher rates of depression.  In the hopes that everyone will become a suicide prevention advocate, the National Suicide Prevention Lifeline has released a new toolkit to help you reach those in need.  And for those looking for 24/7 help there's a website and number to call: 1-800-273-8255.
Special Enrollment Period Announced for Those Who Lost BadgerCare 
Good news!  For those who had lost their BadgerCare Plus coverage on or before April 1, 2014 and how have not yet obtained new health insurance coverage, a new Special Enrollment Period (SEP) is available through November 2nd.  Those transitioning out of BadgerCare should contact the federal Health Insurance Marketplace directly at 1-800-318-2596 to apply for the SEP.

Tuesday, July 8, 2014

Opportunity to provide input

Opportunity to provide input about

The Department of Health Services (DHS) is holding a public 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 <> 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 or by
__ __

*Regular Mail*

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

Al Matano

*E−Mail* <>


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
<>. 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

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!