BADGERCARE GETS A MAKEOVER
Volume 29, Issue 509 February 19, 2008
Anna C. Spencer
As of February 1, uninsured Wisconsin families have a new option: BadgerCare Plus. Proposed by Governor Jim Doyle two years ago, the program aims to provide affordable coverage to all kids and eligible adults by consolidating and extending three preexisting publicly subsidized programs: Medicaid, Healthy Start (for pregnant women and children under 19 who are not in Medicaid) and BadgerCare, the state’s SCHIP program.
Over the next year, BadgerCare Plus is expected to extend health insurance to more than 185,000 formerly uninsured people, including children, parents, pregnant women, farmers and self-employed workers and relatives who care for children enrolled in the program.
According to state estimates, 48,000 Wisconsin children were uninsured for all of 2006 and 71,000 children were uninsured for some portion of that year—despite the fact that roughly two-thirds of those children were eligible for state health programs. State officials blame that high uninsurance rate in part on the multiplicity and complexity of the state’s former insurance programs: the previous programs included 22 eligibility categories, and the state used a complex set of income deductions and exclusions to determine whether a family’s income was low enough to qualify for BadgerCare or Medicaid.
By creating one umbrella of coverage, the state hopes to insure 98 percent of its children, said Jim Jones, deputy director of the Medicaid program. “This is a huge expansion and the largest change to Medicaid since the program began,” he added. “The program has been totally revamped and we’re excited to see what happens.”
To create Badgercare Plus, Wisconsin amended its state plans for Medicaid and SCHIP, and expanded Medicaid to parents earning up to 200 percent of the federal poverty level. The program will be financed in part by the premiums paid by the upper-income families, as well as the savings attained through a reduction in administrative costs and expanded use of health maintenance organizations (HMOs).
The state dealt successfully with the directive that the Centers for Medicare & Medicaid sent out last August by agreeing to use only state money to cover children in families with incomes over 250 of poverty. (See story “SCHIP Enters Turbulent Waters” in this issue of SHN.)
All Children
Under the new program, all children become eligible for BadgerCare Plus, regardless of income. Youth aging out of foster care and adults may be eligible, depending on income.
BadgerCare Plus is divided into two benefit plans. The Standard Plan is open to families who earn less than 200 percent of poverty ($34,340 for a family of three). The plan has the same benefit and co-pay structure as the state’s Medicaid and SCHIP programs. Minimal copays will be required for prescription drugs, provider visits, and hospital and emergency department use. There are no co-pays for well-child checkups, preventive services or prenatal care.
The Benchmark Plan will provide coverage to families with incomes above 200 percent of poverty. Modeled after the largest private insurer in the state, the Benchmark Plan will provide services that are less comprehensive than Medicaid’s and will be administered, in most places, by an HMO. The Benchmark Plan covers doctor or clinic visits, hospital stays and prescription drugs. Co-pays for health-care services range from $5 for prescription drugs to $100 for a hospital stay.
Families with incomes above 300 percent of poverty ($52,800 for a family of three) may purchase BadgerCare Plus policies for their children, but they must pay the full cost: $1,089 a year for each child.
Kid-Focused
One of the biggest changes under the new program is presumptive eligibility for children in families with household incomes of 150 percent or less of poverty ($21,000 for a parent and a child). These children will be immediately enrolled upon applying for BadgerCare Plus, and the families will have the balance of that month and the next month to provide the needed documents.
The state is joining with community organizations to encourage people to enroll in BadgerCare Plus in as many places as possible, Jones said. The state will provide grants to local organizations (including Boys and Girls Clubs, health-care providers and community health organizations) to get the word out and help enroll individuals.
Governor Doyle hopes to expand BadgerCare Plus next year to childless adults. But for now, the state is focused on getting children insured.
For more information about BadgerCare Plus, please visit http://dhfs.wisconsin.gov/badgercareplus/index.htm
People can apply for BadgerCare Plus online at http://access.wisconsin.gov
© Copyright 2008, State Health Notes
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