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2 Governor Doyle’s 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. (more)

3  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’s Health Care Vision (continued)

4  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 statewide  SeniorCare — maintain current waiver Governor Doyle’s Health Care Policy Agenda (more)

5 Key Health Care Policy 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. (more)

6  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 Policy Issues (continued) (more)

7  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 Policy Issues (continued)

8 BadgerCare Plus Affordable, comprehensive health care coverage comprehensive health care coverage for all children in Wisconsin for all children in Wisconsin

9  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 Design

10  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 Population (more)

11  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 Population (continued)

12  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 Simplification (more)

13 BadgerCare Plus Simplification (continued) (more) Current Eligibility System Medicaid / BadgerCare / Healthy Start

14 BadgerCare Plus Simplification (continued) (more) Proposed Eligibility System BadgerCare Plus

15  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 Plus Simplification (continued) (more)

16  Increase use of web-based applications using ACCESS  Use non-traditional locations to sign up kids and pregnant women.  Health risk assessment tool  Crowd out provisions BadgerCare Plus Simplification (continued)

17  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 Benefits (more)

18  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 Benefits (continued) (more)

19  Healthy Living Strategies  Member agreements  Incentives for HMOs  Incentives for individuals  Health literacy/education BadgerCare Plus Benefits (continued)

20  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 Premiums & Cost-Sharing

21  Enroll all participants in managed care within two years  Expand HMOs statewide through incentives BadgerCare Plus Service Delivery

22 SFY 08 SFY 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 Funding ($ million)

23  Discussions began in September  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 CMS Discussions

24  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 CMS Discussions

25 Jason A. Helgerson, MPP Executive Assistant/Policy Director Wisconsin Department of Health and Family Services (phone) (fax) BadgerCare Plus For More Information