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.
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
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