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Governor Doyle’sGovernor Doyle’s Health Care Vision Health Care Vision

Every Wisconsin resident has a right to health care.

State government must do what it can to ensure that residents have access to high quality, affordable care.

No child should ever be without health insurance.

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The rising cost of health care is bad for Wisconsin’s economy.

State government must work with the private sector and other stakeholders to find ways to control costs.

Governor Doyle’sGovernor Doyle’sHealth Care VisionHealth Care Vision

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BadgerCare Plus — all kids covered by health insurance

Healthy Wisconsin — re-insurance pool for catastrophic care

Extend MA coverage to childless adults (<200% FPL) (NEW)

Family Care — expand statewideSeniorCare — maintain current waiver

Governor Doyle’sGovernor Doyle’s Health Care Policy Agenda Health Care Policy Agenda

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Key Health Care Key Health Care Policy IssuesPolicy Issues

Increasing numbers of uninsured In 2004, 91,000 children (more than

7% of total) were without health insurance for at least part of the year.

In 2004, 12%, or 10,000, near poor children were uninsured for at least part of the year.

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Fewer and fewer businesses are offering their employees health insurance.

In 2001, 76% of Wisconsin residents had their insurance coverage provided by their employer.

In 2004, that number dropped to 69%.

Key Health Care Key Health Care Policy IssuesPolicy Issues

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Complex and Costly Eligibility Rules Cash assistance vs. health care safety net Currently, more than 20 different coverage

groups in Wisconsin Discourages enrollment Administrative expense of 800,000

changes that do not affect eligibility costs Wisconsin $12.9 million annually

Key Health Care Key Health Care Policy IssuesPolicy Issues

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BadgerCare PlusBadgerCare Plus

Affordable,Affordable,

comprehensive comprehensive health care health care

coveragecoverage

for all children in for all children in WisconsinWisconsin

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Five strategic goals Cover all kids Provide coverage and enhanced benefits for

pregnant women Make the program simple Promote prevention and healthy behaviors Provide MA access to low-income childless

adults (NEW! Still in development.)

BadgerCare Plus BadgerCare Plus Design Design

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Expansion populations Children with incomes above 185% of FPL Pregnant women with incomes between

185 and 300% of FPL Parents and caretaker relatives with

incomes between 185 and 200% of FPL Caretaker relatives with incomes between

44 and 200% of FPL

BadgerCare Plus BadgerCare Plus Population Population

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Expansion Populations (continued)

Youth (ages 18 through 20) aging out of foster care regardless of income

Parents with children in foster care with incomes up to 200% of FPL

Certain self-employed parents & farmers with incomes up to 200% of FPL

Other Childless Adults (<200% FPL)

BadgerCare Plus BadgerCare Plus Population Population

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Simplification is a key part of this initiative.

Simplified gross income test Only two deductions

• Student earned income disregard• Child support payment disregard

BadgerCare Plus BadgerCare Plus SimplificationSimplification

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BadgerCare Plus BadgerCare Plus Simplification Simplification

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Current Eligibility System

Medicaid / BadgerCare / Healthy Start

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BadgerCare Plus BadgerCare Plus Simplification Simplification

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ProposedEligibility System

BadgerCare Plus

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Presumptive eligibility children below 150% of FPL pregnant women

Spenddown for pregnant women to 300% of FPL

Spenddown for children to 150% of FPL

BadgerCare PlusBadgerCare PlusSimplification Simplification

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Increase use of web-based applications using ACCESS

Use non-traditional locations to sign up kids and pregnant women.

Health risk assessment toolCrowd out provisions

BadgerCare Plus BadgerCare Plus Simplification Simplification

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Two distinct plans Standard Plan (current Medicaid benefit

package) for those with incomes under 200% of FPL

Benchmark Plan (new) for those with incomes above 200% of FPL and certain self-employed families

BadgerCare Plus BadgerCare Plus BenefitsBenefits

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Benchmark plan is based on largest, low-cost, commercial plan

Four benefits added to basic plan Prescription Drugs Early Childhood Development Services Dental Services Mental Health/AODA

BadgerCare Plus BadgerCare Plus Benefits Benefits

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Healthy Living Strategies Member agreements Incentives for HMOs Incentives for individuals Health literacy/education

BadgerCare Plus BadgerCare Plus BenefitsBenefits

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Charge premiums to higher income groups (start at 150% for adults and 200% for children/pregnant women.)

Family premiums capped at 5% of income.

Standard Plan participants pay nominal copays.

Benchmark Plan participants pay copays more in line with private plans.

BadgerCare Plus BadgerCare Plus Premiums & Cost-SharingPremiums & Cost-Sharing

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Enroll all participants in managed care within two years

Expand HMOs statewide through incentives

BadgerCare Plus BadgerCare Plus Service DeliveryService Delivery

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SFY 08SFY 08 SFY 09SFY 09

Benefit Cost $ 9.1 $ 37.8

Admin Cost $ .8

Total Cost $ 9.9 $ 37.8

HMO Ex. Savings $ 17.4 $ 37.6

St. Adm Savings $ 1.3 $ 2.5

Total Savings $ 18.6 $ 40.1

NET COSTS ($ 8.7 million) ($ 2.3 million)

BadgerCare Plus BadgerCare Plus FundingFunding

($ million)

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Discussions began in September 2006. Clear message – Utilize the DRA!!!! We are attempting to get as much accomplished

through state plan amendment as possible. Negotiations have been kept at a staff level

throughout election season. State is in the process of ramping up the

discussions.

BadgerCare Plus BadgerCare Plus CMS DiscussionsCMS Discussions

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Areas of contention:1. Some cost sharing, especially the premium requirement,

for pregnant women above 200% of the FPL.

2. Allowing children, parents, and other adult caretaker relatives to be eligible for SCHIP funding when they have coverage by insurance, even when the employer is paying less than 80% of the premium cost for that individual or family.

3. The concept of transitional grandfathering that would allow adults no longer eligible for health care coverage due to changes in policies (Family Fiscal Unit, 12 Month Medicaid Extensions, etc.) to participate for 18 months.

BadgerCare Plus BadgerCare Plus CMS DiscussionsCMS Discussions

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Jason A. Helgerson, MPPExecutive Assistant/Policy DirectorWisconsin Department of Health and Family

Services608-267-7284 (phone)608-266-7882 (fax)helgeja@dhfs.state.wi.ushttp://dhfs.wisconsin.gov/badgercareplus/

BadgerCare Plus BadgerCare Plus For More Information For More Information