Healthwatch Update

Medicaid on the Chopping Block

On a Friday afternoon, on the cusp of one of the busiest sports weekends in Wisconsin history, the Department of Health Services opened the lid on a squirming can of worms--details on new, drastic Medicaid budget cuts. The proposal put forth requires tens of thousands of Wisconsin families to pay more for their health care coverage.

Outlined in the cuts are unprecedented reductions in benefits and services for families above 100% of the federal poverty level. Creating the "Alternative Benchmark Plan," DHS is asking families above 100% FPL (equivalent to a family of 4 making approximately $22,000 a year) to participate in increased cost sharing with a reduced benefits package. More than 200,000 individuals could be impacted by these proposed changes. Families making 150% FPL would also pay increased premiums. In fact, if you have "access" to private insurance, you will not be eligible for BadgerCare if you contribute less than 9.5% of your household income to that coverage. (For a family of 3 at approximately 150% FPL, premiums will increase 2100%.)  Failure to pay a timely premium would bar you from the program for a year.
The sports weekend is over and we need to pay attention.
Additional details of the proposal show how Wisconsin will seek changes to the federal “maintenance of effort” requirements. These changes include restricting BadgerCare Plus from anyone who has access to private insurance, re-calculating family incomes, eliminating backdating on applications, increasing premiums, allowing for faster terminations of policies, restricting 19-26 year olds from BadgerCare Plus, instantly denying BadgerCare Plus if verifications are late, and more.

Waiver is Already Submitted

Even though DHS Secretary Dennis Smith had previously said Wisconsinites would be able to read and review the Waiver Request before it was submitted to the Centers for Medicare and Medicaid Services (CMS), the request for a waiver has already been submitted, received and is being reviewed. The agency must approve the request, deny it or formally request more information within 90 days.

Holding Parents & Core Plan Members "Hostage"

Back in Wisconsin, recall that the Walker Administration set a Dec. 31 deadline for getting approval of a waiver from the federal government. If not approved, the state will drop 53,000 adults currently on BadgerCare Plus programs who earn more than the 133% FPL.

HealthWatch Wisconsin will be reviewing the proposed cuts, those that need federal permission and those that can be implemented after a simple passive review by the Joint Finance Committee, and will be providing feedback in an edition of the HealthWatch WatchDog and on its website over the next few days.

BadgerCare Plus Basic Premium Increase-Again

Program costs continue to increase as only the highest cost patients remain on the plan

All BadgerCare Plus Basic Plan members received a letter last week informing them that premiums for the Basic Plan will be increasing yet again. This is the third premium increase in the last 6 months. The Basic Plan was originally designed to be completely self-funded, but as people who cannot afford the premiums fall off of the program - and the sickest and most desperate remain - the costs will continue to increase. An individual on the BadgerCare Plus Basic Plan with an income at 100% FPL will easily be paying 35.8% of his monthly income in Basic Plan premiums.
This announcement was made only by letter to current Basic Plan members, not by an Operations Memo or other public notice, as in the past. The premium increase will begin with the November benefit month. The first $325 premium will be due on October 5.

"Introduction to Private Insurance: Health Reform" has been added to the HealthWatch Wisconsin On Demand Training Portal!

If you enjoyed our last two web cast presentations introducing issues in private insurance, visit the HealthWatch Training Portal to watch the final training in our three-part series! Now Available FREE for Members of HealthWatch Wisconsin: "An Introduction to Private Insurance, Part 3" presented by Public Interest Attorney Bobby Peterson.  In this training, learn or refresh your memory on: 

• Health Reform Changes Impacting Children
• Consumer Protections in Health Reform
• The Buying and Selling of Insurance, Including Exchanges
• Medicaid Expansions
• And More!

This current training is an introductory, basic level training appropriate for all learning levels.

HealthWatch Wisconsin's Skill Meter

HealthWatch Members and Subscribers are able to access on demand training content, free of charge, a benefit of HealthWatch Wisconsin. Members and Subscribers can login to the HealthWatch Training Portal to view training content. Having trouble logging in? Give us a call! 1-800-585-4222 ext. 204.

Watch your inbox for an announcement on our "Introduction to Private Insurance, Part 3," a training entirely devoted to the impact of health reform on private health insurance in Wisconsin.

 Grapevine

Are You Having Trouble Applying for Medicaid Online?

It has been brought to our attention recently that those trying to apply for Medicaid online using access.wisconsin.gov or are attempting to renew their Medicaid application online are getting “error message” and other such warnings when they attempt to log-in to their accounts or when they hit “submit” on their applications. The HealthWatch Update staff would like to hear from you:

• Are you experiencing any such “technical difficulties?”
• Are you getting a warning message or an error that says you have “Timed-out” or hit a “Forbidden area?”

If so, please let us know WHAT error messages you see, WHEN the message appears (upon hitting “Submit” or when you “Pay a Premium,” or other examples), and HOW frequently you see these errors!

ABC for Health's Bobby Peterson Wins Advocacy Award!

Congratulations to Bobby Peterson, public interest attorney and Executive Director of ABC for Health. Bobby is the 2011 recipient of the Sally Sunde Family Advocate Award. This award, presented by Community Shares of Wisconsin is given to an individual whose work has had significant impact on the lives of children and families.

NEW: Core Plan Waiting List "Counter"

One hundred eight thousand, six hundred and three people, and counting

This number represents the number of childless adults in Wisconsin sitting on the BadgerCare Plus Core Plan Waiting List as of 12:00pm on September 27, 2011. These individuals should be effectively screened by the Department of Health Services/Enrollment Services Center upon entering the abyss of the waiting list for different health coverage programs, including, but not limited to, Elderly, Blind and Disabled Medicaid, Medicaid Assistance Purchase Plan, HIRSP, or SSI/SSDI.

Help Keep the Counter Current! Click Here to email HealthWatch Wisconsin with the number you or the individual you are helping has on the waiting list. Please tell us the waiting list number, and the time/date you applied.

Keeping Count: The BadgerCare Plus "Counter"

When the BadgerCare+ Express traveled Wisconsin educating families and advocates on BadgerCare Plus, we did a lot of "myth-busting!" One of our main messages was "BadgerCare Plus for Children, Families and Pregnant women is still an option for families," despite frozen enrollment for the Core and Basic Plans. The HealthWatch Update staff is keeping an eye on BadgerCare Plus enrollment for children, adults/caretakers, and pregnant women. As numbers are made available, we will update them here:

Seven hundred forty seven thousand, seven hundred and seventy-eight children, adult/caretakers and pregnant women are enrolled in BadgerCare Plus as of the end of August 2011. (This number does not include adults on the BadgerCare Plus Core Plan.)

BadgerCare Plus for Pregnant Women: When Does Pregnancy Coverage “End?" (Part 1)

Pregnant women applying for BadgerCare Plus coverage will be asked to verify their income in the month they apply. The county economic support worker will test that household income against an income limit specifically for pregnant women. For pregnant citizens and pregnant lawful permanent residents, that limit is 300% FPL. (Note, pregnant women may exceed this limit, but would be responsible for meeting a deductible.) These FPL limits are important, as they differ quite drastically from the FPL limits for parents. Once a citizen woman delivers, she is no longer considered a pregnant woman, and thus she must meet BadgerCare Plus financial eligibility rules for parents.  Parents under BadgerCare Plus cannot exceed 200% FPL.

It is possible, however, to have BadgerCare Plus benefits continue past the date of delivery. After delivery, a new mother will receive 60 days of the same BadgerCare Plus coverage the mom had while pregnant. Once the end of the month in which the 60th day comes, the new mom won’t lose coverage—instead, the county economic support worker will re-verify the mom’s income. If the new mom’s income exceeds 200% FPL, then she will lose coverage; if her income falls under 200% FPL, she will continue with BadgerCare Plus coverage.

For Example: Lucy applied for BadgerCare Plus as a pregnant women, US citizen. Her household income was 250% FPL when she applied. She was found eligible for BadgerCare Plus as a pregnant woman. Lucy had a baby girl on April 8, 2011. Lucy will continue to have coverage until June 30th (the end of the month in which the 60th day post partum occurs.) Since she is now a parent and the new FPL limit to meet is 200%, after her 60 days of post partum coverage ends, the county she lives in will at that time re-determine her eligibility. Lucy’s income in July is the same as it was when she applied for BadgerCare Plus, 250% FPL. She is over income for benefits, and thus loses BadgerCare Plus.  (Lucy’s newborn daughter will not lose benefits, but will have BadgerCare Plus Benchmark Plan coverage.)
State & National News

Analysis and Comment

Wisconsin Receives Another Rate Review Grant, Disbands Committee
Wisconsin is one of 29 states receiving federal money in line with the Patient Protection and Affordable Care Act (PPACA). The amount of $3,958,844 is intended to improve rate review of proposed insurance premium hikes to prevent unreasonable increases and protect patients.
While the federal governement has no power to veto increases, individual states have some regulatory power. The grant will assist in improving technology and increasing the regulatory body to more efficiently review proposals and better determine whether increases are unreasonable.
The announcement of the grants on September 20 was followed by an announcement by the state's Joint Legislative Committee on September 27 of the decision to disband the Special Committee on Health Care Reform Implementation. The special committee was charged with studying and making recommendations for changes to state statutes and administration in preparation for provisions of health care reform. Wisconsin is one of 12 republican controlled states receiving this federal grant, of which some are suing to overturn PPACA.
Insurance companies are unhappy about improvements to rate review and regulation, claiming increases are necessary due to increase in underlying medical costs. Rate review allows states to examine proposed increases exceeding 10 percent to determine whether such hikes are justified or unnecessary. Beginning September 1, insurance companies are already required to post increases and full explanations to their websites, improving transparency.
Headlines
Spillover Effects of Community Uninsurance on Working-age Adults and Seniors
Robert Wood Johnson Foundation, Sept. 2011
This article explores the indirect, or spillover, health care effects on people who are currently insured, specifically privately insured working-age adults (18 to 64) and Medicare enrollees (65 and older), when the community uninsurance rate is high.
Supreme Court to take on Health Care Reform
Channel3000.com, Oct. 3
One of the little-known prerogatives of the U.S. Supreme Court is the justices' discretion to refuse any case on the merits presented to them for review
Wis. To face $444M in Medicaid Funding Cuts
Badger Herald, Oct. 2
Health Services revealed plans late last week to cut an estimated $444 million from Medicaid in order to balance the state’s budget.
State Officials Announce Sweeping Medicaid, BadgerCare Changes
Channel3000.com, Oct. 1
Wisconsin health officials have released a sweeping package of sweeping Medicaid reforms designed to save more than half-a-billion dollars
State wants to shift some Medicaid recipients to lower-cost plans
Milwaukee Journal Sentinel, Sept. 30
To fill a half-billion dollar budget hole in state health programs, Gov. Scott Walker's administration wants to raise premiums sharply for some families and shift hundreds of thousands of residents to lower-cost state plans or private plans.
Health Insurance Costs Rising Sharply this Year, Study Shows
New York Times, Sept. 27
A new study by the Kaiser Family Foundation shows that the average annual premium for family coverage through an employer reached $15,073 in 2011, an increase of 9 percent over the previous year.
Beware late payments to BadgerCare Plus Basic
Wisconsin Radio Network, Sept. 26
State Senator Jim Holperin (D-Eagle River) says the state Department of Health Services is adamant about timely payments for BadgerCare Plus Basic. So much that late payments lead to loss of health care coverage.
Bartering for Health Care: Yardwork for Treatment
NPR, Sept. 26
True North Health Center in Falmouth, Maine, accepts "time dollars," in addition to real dollars. Patients perform services in the community, like raking leaves, to earn the currency, and they can spend it for care at True North.
Priceless preemies, costly care
Milwaukee Journal Sentinel, Sept. 24
The tinier the babies, the greater the miracles - as well as the cost, both financial and emotional
Young Adults Make Gains In Health Coverage
Kaiser Health News, Sept. 22
New data indicate as many as a million young adults have signed up for health insurance in the last year, offering evidence that this 2010 health law benefit is proving to be popular.
Ten Questions To Ask Your Doctor
NPR, Sept. 21
Don't be afraid to ask about the cost of the treatment or test your doctor recommends. Depending on what you find out, go right ahead and haggle over the price or ask about less expensive options.
Preemies may face higher death rates as adults
Reuters, Joelving, Sept. 21
Health problems are common among premature babies, who are more likely to die than their full-term peers during the first few years of life -- and they may also face slightly increased death rates as young adults, a study said.
Groups come together to form statewide Healthy Choices Coalition to reduce barriers to dental care
Healthy Choices Coalition, Sept. 21
Coalition members urge creative steps to improve Wisconsin’s oral and overall health.
HHS Pushes State Partnerships For Insurance Exchanges
Kaiser Health News, Werber Serafini, Sept. 19
The federal government is worried that dozens of states may opt out of running these insurance marketplaces and leave that job for Washington.
States Head To DC With Questions About Health Insurance Exchanges
The Hill, Sept. 19
Leaders from the Health and Human Services Department will discuss exchanges with representatives from 46 states, Washington, D.C., and the territories.
Tackling rising health care costs - Now is the time to act
Sen. Kathleen Vinehout, Sept. 19
We can continue to fight the implementation of federal health care reform in court and in public discourse or we can carefully examine the options and create a new approach within the federal rubric using our unique Wisconsin ingenuity.

Connection Between High Percentage of Minority Trauma Patients and Increased Mortality
Archives of Surgery, Sept. 19
Patients treated at hospitals with higher proportions of minority trauma patients have increased odds of dying, even after adjusting for potential confounders.

ABC for Health: Opposes AB 210, an insurance bill rolling back consumer protections
Wispolitics.com, Sept. 16
Assembly Bill 210, touted as the bill to “bring Wisconsin into compliance with the Affordable Care Act,” instead abandons the progress Wisconsin has made to create a transparent process for consumers.
Click here for more health care news!