Thursday, June 28, 2012

WAWH Supporter E-Update
BREAKING NEWS: Supreme Court Upholds Affordable Care Act

Wisconsin Alliance for Women's Health Statement on Supreme Court Decision to Uphold the Affordable Care Act

MadisonIn response today's decision by the Supreme Court to uphold the Affordable Care Act, the Wisconsin Alliance for Women's Health Executive Director, Sara Finger, released the following statement:

"The Supreme Court's decision to uphold the Affordable Care Act (ACA) including the individual mandate is a tremendous win for women and their families, including the 50 million Americans, and over 500,000 Wisconsinites, 180,000 Wisconsin women, currently without insurance.

The Supreme Court ruled, now it is up to the states, including Wisconsin, to make health care, including comprehensive women's health care, available and affordable to keep women and families healthy.  Moving forward with implementation of the ACA, insurance will cover more of what we need, when we need it, making women healthier and making it easier to take care of ourselves and our families.
We'll have peace of mind that our children, teens and young adults will be safe, healthier and covered. Already, parents of 94,700 Wisconsin children with pre-existing conditions, like asthma or diabetes, have peace of mind knowing their child won't ever be denied coverage.

We'll be healthier. All new insurance plans must make basic women's health services, like [mammograms, pap smears, cancer screenings] available with no co-pay, services that many women put off or just don't get because of the high cost. Already, 413,000 Wisconsin women gained access to basic women's health services with no co-pay. Starting August 1st, we can celebrate the addition of birth control coverage to this list of services that must be covered without co-pays.  By covering services like birth control, the new law saves families $26 a month on average - the cost of a trip to the grocery store - helping everyone in these tough economic times.

We won't have to worry that we'll get kicked out of our insurance plan because we get sick. The law already prevents insurers from cancelling your policy if you develop breast cancer or other serious illnesses.

We won't experience discrimination because we have a pre-existing condition. Already under the new law, 17 million children can no longer be denied coverage due to a pre-existing condition, including 94,700 in Wisconsin, and starting in 2014 neither will adults.  And women will no longer have to pay more than men for the same insurance plan.
This decision is a critical victory for Wisconsin women and their families.  We are already feeling the positive impact of reforms on our health and economic security, and look forward to full implementation in Wisconsin."

To learn more about what's at stake for Wisconsin women and girls with the Supreme Court decision, visit our Raising Wisconsin Women's Voices site at or our blog

Wednesday, June 20, 2012

WAWH Supporter E-Update
Protect Contraception as Prevention
 for ALL Women! 
Submit Your Comments to the Obama  Administration Today! 
cip logo
Speak Up & Submit Comments to the Obama Administration - All Women Need Access to Contraception without Co-pays
The Wisconsin Alliance for Women's Health has celebrated recommendations that contraception, yearly well-woman visits, support for breast feeding, counseling for sexually transmitted infections, and screening and counseling for domestic violence, among others, are essential women's preventive health services and therefore health insurers should be required to cover them at no cost to women.   

The Obama Administration is currently collecting comments on its proposal to "accommodate" religiously-affiliated organizations that object to covering contraceptive services without cost-sharing, as required under the federal health care law.  

Your voice is vital to make it clear to the Administration that women who are subject to the accommodation should have the same seamless access to no-cost contraception as those who are not.  Please make your voice heard!  Comments are due on June 19th.  The following is a sample message you can included when submitting your comments:

Subject: ANPRM: Certain Preventive Services Under the Affordable Care Act, CMS-9968-ANPRM, Docket ID: CMS-2012-0031

If the Departments move forward with the accommodation, it must be structured in a seamless way that does not unfairly disadvantage those individuals subject to it or harm their health. 

The definition of who qualifies for the accommodation must be limited and should not extend to for-profit employers.  In no way should the existing religious employer exemption be expanded.   The accommodation must be automatic, seamless, without charge, and accompanied by clear notice and critical protections like continuation coverage. 

I am fortunate to live in a state that already has a requirement ensuring that women are provided with contraceptive coverage, with no exceptions for religious employers.  It has made a difference in my life and the lives of women and families across the state.  I strongly support the Departments' statement that law's like Wisconsin's will continue.  Women in our state should not lose access to benefits they currently have.

In order to fulfill the promise of the preventive services provision of the health care law, women who are subject to the accommodation must have access to no-cost contraceptive coverage to the same extent as those who are not.


To send a message and to submit your comments, link here.  Click on the "Comment Now" button on the upper right.  Feel free to use the text above in your message to the Administration.  

Be sure to also mobilize your friends and neighbors to speak out on this issue by forwarding this message on and by posting it to Facebook and/or Twitter. 

Monday, June 18, 2012

Wisconsin's Insurance Commissioner: Request: DENIED

In our June 1 Update newsletter, we covered Wisconsin Commissioner of Insurance Ted Nickel's special request to the Feds asking to side-step private health insurance rate review thresholds under the Affordable Care Act.
In his May 7, 2012 request letter, Commissioner Nickel sought a state specific threshold for rate review. He said that the Affordable Care Act’s rate review threshold of reasonableness was “inappropriate” for Wisconsin. Unfortunately for the Commissioner, his request lacked actuarial data and failed to include any public input. Additionally, Commissioner Nickel’s letter incorrectly characterized the current rate review procedures in Wisconsin. ABC for Health submitted comments to the Feds on Commissioner Nickel's request.
In a letter dated June 1, the Feds replied to Commissioner Nickel, denying his request. They actually said the Commissioner didn't follow the directions. Therefore, the 10% rate review threshold will continue to apply in Wisconsin. The Centers for Medicare and Medicaid Services (CMS) writes:
"CMS has determined that we are unable to accept your proposal because it does not set forth a proposed State-specific threshold to be used to determine rate increase filing that would be subject to review in the State of Wisconsin. Instead, the proposal requested approval for a methodology and permission for the Office of the Commissioner to use the methodology to arrive at a State-specific threshold on its own. This proposed approach is not consistent with the instructions presented in the Guidance, and would not permit the announcement of a State-specific threshold by June 1, as required under 45 C.F.R. 154.200(b)." (emphasis added.)
CMS posted ABC for Health's public comment on their web page.
HealthWatch has been tracking Wisconsin's meager, even hollow attempts at implementing the rate review provision of health reform since spring of 2011 when HHS first announced that the new regulation would take effect on September 1, 2011. Want to learn more? Click here to read a special edition of the HealthWatch Reporter devoted entirely to this issue!

A "Win" For Mental Health Parity

Good news came out of California this week, signaling that progress is being made in holding insurers accountable to state mental health parity laws. A federal appeals court issued a decision that was structured around the state's mental health parity law, finding that even when a private insurance plan excludes mental health treatment, it still must be covered under state law. Recall that in 2008, the federal government passed the Wellstone and Domenici Mental Health Parity Act, which requires individual plans and companies with more than 50 employees to provide the same coverage for physical ailments and mental health services. States have adopted their own mental health parity statutes that demand increased coverage, in addition to existing insurance mandates; the Affordable Care Act also includes mental health services on its list of essential health benefits, which state-licensed health insuring organizations are required to cover in their health insurance plans. 
In the case that went to California's court of appeals, a woman's coverage at a residential treatment program was denied, and insurer Blue Shield asserted that residential treatment wasn't "listed" in the Mental Health Parity Act for the state. The Ninth Circuit ruled the "law requires insurers to pay for all medically necessary treatment for severe mental illness." Kenny Goldberg of KPBS public broadcasting in San Diego reports that the deputy commissioner with the California Department of Insurance has seen other insurers try to dodge paying for mental health treatments. He quotes her as saying, "Despite the passage of the mental health parity law more than a decade ago, insurers have just been reluctant and resistant to complying." However, it often falls to the consumer to "know the rules" in order to challenge the insurer! In California, insurers MUST cover treatments for severe mental illness, even if the policy excludes it. In Wisconsin, Governor Doyle signed "mental health parity" legislation into law in April 2010.  Wisconsin’s new law applies to all businesses in the state with at least 10 employees.

A Closer Look at Mental Health for Children

Guaranteed Coverage Through EPSDT (HealthCheck)

Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is a comprehensive, preventive well-child screening program for Medicaid-eligible children (under age 21). Congress added the EPSDT component to Medicaid in 1967 in response to documented, widespread, preventable mental and physical illnesses among low-income children and to promote the early detection and treatment of health conditions that could lead to chronic illness or disabilities. Called "HealthCheck" in Wisconsin, the purpose of EPSDT is to assure that all Medicaid-enrolled children receive periodic, comprehensive health screening exams resulting in the identification and provision of medically necessary health care services.
Why bother with HealthCheck? Here are just a few of the many reasons:
  • Children and families struggle accessing dental care
  • Children hit routine limits to mental health care
  • EPSDT offers broad coverage
  • EPSDT is less expensive than private coverage
  • Per Capita, the cost of insuring a low-income child under Medicaid saves money
  • Benchmark Plan affects coverage for thousands of Wisconsin children under age 21
  • All Benchmark-enrolled children are eligible for Standard Plan benefits
  • Coverage limits of Benchmark Plan DO NOT APPLY
  • Children get the services they NEED and are entitled to under federal law
Yet, problems using HealthCheck persist. Providers skip "ages and stages" questionnaire due to time constraints during well child visits. Families are having trouble navigating mental health treatment, especially eating disorders/OCD and residential treatment. And, the case out of California reminds us that no matter the rules on the books, hoops and hurdles, and sometimes legal action is required to ensure the screening and treatment guaranteed in federal and state law! Stay tuned to future HealthWatch newsletters and publications on EPSDT and HealthCheck in Wisconsin, as we describe children's rights, the rules and the requirements to be assured all medically necessary services.

Core Plan Law Suit Moves Forward

In the May 18 edition of the HealthWatch Reporter newsletter, we discussed the continuing dramatic growth the BadgerCare Plus Core Plan Wait List and plummeting enrollment numbers. Since that time, much has happened. The enrollment continues to drop and the Wait List continues to grow, for one. The exchange of letters among Wisconsin Representative Jon Richards and Representative Tamara Grigsby and the Feds highlighted the shortcomings of the Wisconsin Department of Health Services (DHS). CMS said the Walker Administration MUST submit a plan by August 1 to the federal government that addresses the large number of individuals falling off the Core Plan. They continued that Wisconsin "will conduct targeted outreach" to get people back onto the Core Plan (after the new restrictive re-enrollment policy begins.) Yet, we would have gone further, and demanded the Wait List be opened, and the "surplus" be invested in the health of the people of Wisconsin. Finally, Legal Action of Wisconsin filed suit. They allege that DHS has violated state and federal law by not enrolling people in the program. The media is running wild with this news, citing the HealthWatch Wisconsin Core Plan Counter to demonstrate the size of the Core Plan Wait List. Below are a few news clippings from this week:

BadgerCare Plus Changes Take Effect July 1

In two weeks, the new BadgerCare Plus eligibility and enrollment rules will go into effect. Below, you'll find a summary of the changes, as well as the projected impact on adults and children on BadgerCare programs. You'll also find a listing of strategies to help keep families connected to their existing coverage. If you know of a parent or patient that will LOSE BADGERCARE COVERAGE because of the changed policies, email HealthWatch Wisconsin! We want to hear from the people of Wisconsin!
And don't forget, if you join or renew your HealthWatch membership before July 1, you will receive your own BadgerCare Plus Eligibility Index, a handy reference that will help you make sense of the new premiums and policy information.
Summary of Changes to BadgerCare Plus
According to Ops Memo 12-25, the following policy changes will go into effect July 1, 2012:
  • New premiums for non-pregnant, non-disabled adults above 133% FPL enrolled in BadgerCare Plus or the Core Plan;
  • 12 month restrictive re-enrollment for those who fail to pay premiums;
  • Crowd-out for non-pregnant, non-disabled adults (parents or caretakers) above 133% FPL who have access to employer sponsored coverage and contribute less than 9.5% of their household income to the premium payment; and
  • Elimination of retroactive eligibility (backdating) for non-pregnant non-disabled parents and caretaker relatives between 133% and 150% FPL.
DHS promised to issue a series of more detailed memos with policy changes and definitions. Stay tuned to the Update newsletter for coverage of those Ops Memos on the new policies!
Strategies for Keeping Wisconsin's Families Covered
In just two weeks, the new BadgerCare Plus rules will be enforced. Families will be subject to new premiums, new reporting requirements, and new penalties for non-compliance. Many adults will lose coverage. Some families won't learn of the rule changes until they are faced with a coverage denial at a hospital, pharmacy or clinic. Below are a few suggestions and strategies of how to help families encountering rule changes.
Applying for Coverage: You should never be told over the phone that you are not eligible for coverage. You can mail or fax an application, you can apply by phone, or you can apply online. You should never be discouraged from applying using any of these options. Contact an advocate as soon as possible if you have problems completing or filing an application.
Renewing Coverage: It is important that you renew your coverage when you receive a “Notice of Review and Reapplication” in the mail. Read this notice carefully. It will tell you how to renew your coverage by mail, telephone, online or by making an appointment.
RENEWAL TIP: Mark the date on your calendar that is one month before your renewal is due. This way, you’ll have plenty of time to gather the documents you’ll need to verify  income, insurance, and other information. If you are an advocate working with a family--calendar renewals for your patients!
The renewal process might require you to submit verifications of income and insurance, among other things. Have this information handy to avoid delays. Your health coverage will be renewed if you are still eligible. If you do not reply to the notice, you may lose your coverage and be restricted from coverage for 12 months. After you renew your eligibility, call the Managed Care Enrollment Specialists at (800) 291-2002 with questions or concerns about continuing in your current HMO.
Report Changes: You MUST report all changes to your county consortium within 10 days.  You can find the phone number for your consortium here. Some examples include:
  • Change in income
  • Change in address
  • Change in family size/birth of a baby
  • Change in employment status
Missed Premiums and Restrictive Re-enrollment: If you are an adult enrolled in BadgerCare Plus, and you are now required to pay premiums, you MUST pay them on time. A program enrollee has until the last day of the month to pay a missed premium. Failure to pay premiums on time may result in a loss of benefits. If an adult fails to submit a premium payment by the last day of the month, he or she will enter the restrictive re-enrollment period and be ineligible to reapply for coverage for 12 months. If parents or caretakers fail to submit a premium payment for a child enrolled in BadgerCare Plus by the last day of the month, the child enrollee is subject to a 6 month restrictive re-enrollment period.
It's important to note that the restrictive re-enrollment period only applies as long as the adult’s income remains 133% FPL or higher. If the individual's income drops below 133% FPL during the 12 months, the restriction is lifted and the individual is eligible to apply for benefits. This rule applies to Core Plan enrollees, as well as adults enrolled in BadgerCare Plus.
For more information about the upcoming changes, including what to do if your application is denied and how to work with your HMO, CLICK HERE

Thursday, June 7, 2012

State Sued for Not Enrolling BadgerCare Participants

More than 130,000 childless adults waiting for coverage

By Lisa Kaiser

Two Milwaukee women and Legal Action of Wisconsin are suing the state Department of Health Services (DHS) for failing to enroll the women in the BadgerCare Plus Core program.

The Plus Core program, which serves low-income childless adults with no other health insurance options, has an enrollment cap of 48,500 individuals.

Yet in April, only 25,800 people were enrolled.

About five times that number—131,000 individuals—were on the waiting list.

Two of those individuals—Teresa Charles and Susan Wagner, of Milwaukee—are eligible for BadgerCare Plus Core but have been on the waiting list for more than two years.

Charles has a chronic lung condition and no health insurance.

Wagner suffers from a seizure disorder and has no health insurance.

Charles and Wagner contend that DHS is violating state and federal laws by failing to enroll them in the program within 60 days.

In May, state Rep. Jon Richards (D-Milwaukee) and state Rep. Tamara Grigsby (D-Milwaukee) had asked the federal government to look into Wisconsin's potentially illegal waiting list for the BadgerCare Plus Core program.

On Tuesday, Richards agreed with the lawsuit's plaintiffs that the state must enroll qualified individuals within 60 days until it reaches the enrollment cap.

“That's the law,” Richards said. “Unfortunately, the Walker administration has specifically not enrolled people in that program even though there is room available to provide insurance under that program.”

Both Charles and Wagner would have been eligible for the General Assistance Medical Program (GAMP), a precursor to the Plus Core plan in Milwaukee County and elsewhere. GAMP didn't have a waiting list at the time it was folded into BadgerCare in 2009.

“That's the frustrating part,” Richards said. “We eliminated the program that they would have relied on and they [the Walker administration] are not letting them in the program we created to take its place.”

Paying for BadgerCare
BadgerCare Plus Core, like other Medicaid programs, is funded by both the state and federal government.

The federal government pays 60%, while the state picks up 40% of the cost. The federal share is money that would have been sent to hospitals that provide a substantial share of medical care to uninsured individuals. The state share comes from a fee levied on hospitals as well, although it is not specifically earmarked for BadgerCare. The thought was that instead of paying for uncompensated care at hospitals, the federal and state governments would provide funds for insurance for low-income Wisconsinites.

DHS spokeswoman Stephanie Smiley couldn't comment specifically on the lawsuit. But she wrote in an email to the Shepherd that the federal government requires the program to be “budget neutral” and that the state would exceed the amount budgeted for the program if it took people off the waiting list.

“The department is not in a position to open enrollment to the Core plan because we are currently tasked with finding additional savings to the Medicaid program,” Smiley wrote.

But an analysis by Jon Peacock, research director for the Wisconsin Council on Children and Families (WCCF), indicates that the state likely has enough funds to enroll more people than the 25,800 individuals currently covered.

Peacock found that the budget bill assumed that the enrollment freeze would be lifted and individuals would be taken off the waiting list. At budget time, it was assumed that 43,000 childless adults could be covered per month with a cost to the state of $57.8 million annually. Estimates have fluctuated based on updated data, Peacock wrote, but he calculated that the state could afford to serve an estimated 34,400 individuals—roughly 9,000 more people than are currently enrolled in BadgerCare Plus Core.

“When DHS imposed the moratorium on additional enrollment, state officials said they would start taking people off the waiting list once enrollment fell to the point where average monthly spending had declined to the cap set by the waiver agreement,” Peacock wrote in a paper to be released publicly this week. “The state reached that point more than a year ago, but the Walker administration has yet to lift the moratorium on Core Plan enrollment.”

Wisconsin Alliance for Women's Health
PO Box 1726 Madison, WI 53701
[p] 608.251.0139 | 866.399.WAWH | [f] 608.256.3004

Monday, June 4, 2012

Tomorrow Tuesday, June 5th: Statewide Recall Election -  Make Your Vote Count!

For this election you will not need a photo ID, but it is still important for you to be prepared to vote. Voting is one of the most important ways that a BadgerCare advocate can make a difference.

Polls open at 7am tomorrow and are open until 8am. To find your polling place link to

Residency: Citizens can still register at the polls, however they must be residents of a municipality for 28 consecutive days to register as a voter from that address. Those who are not registered must provide acceptable proof of residence to register, such as a utility or other bill. If you have moved within 28 days of Election Day you can still vote at your former place of residence.

Photo ID and Signatures: 
Although you do not need a photo ID for this election, you will be asked to sign the poll book. You can use a stamp or mark if necessary. If you are unable to sign due to a physical disability, you can request an exemption.

For more information, visit  

If you experience any problems at the polls, call 1-866-OUR VOTE (1-866-687-8683) immediately to report what happened and protect the vote.    
Thank you!
Thank you for supporting BadgerCare and Medicaid.  Be sure to forward this email to others letting them know that MEDICAID MATTERS!  For more information and to join the Save BadgerCare Coalition, visit: