Expanding Health Care Coverage and Making It Affordable

E-newsletter #60/November 18, 2010

In 2006, Wisconsin Gov. Jim Doyle announced his “Affordability Agenda.” It included a goal of expanding health care coverage to 98 percent of all the state’s residents. An ambitious plan in any economy, it was even more of a challenge with what was to come just a year later—The Great Recession.

Regardless of the economy, Wisconsin pushed ahead with BadgerCare Plus, one of eight national winners of CSG Innovations Awards.

“The direction was to look at the Medicaid and (state children’s health insurance) programs and try to condense them into something more usable and understandable to members themselves,” said Melissa Henderson, deputy bureau director of the Bureau of Enrollment Policy and Systems with Wisconsin Medicaid. “Really, the goal was to provide consistent benefits to them so they weren’t jumping between programs. It also allowed providers to have a consistent relationship with people in the program.”

BadgerCare Plus consolidated all of the state’s previous medical assistance programs into one and simplified the enrollment process. Instead of eight different income tests, there was just one. An Internet site was created that walks people through enrollment and also enters them into any other assistance programs, such as food stamps, for which they may qualify. People may enroll by mail, by phone and in person. Other community resources, such as federal Women, Infants and Children clinics or churches, also were trained on how to help people sign up for benefits.

BadgerCare Plus greatly expanded who could get medical coverage. Any uninsured child under age 19 qualifies, although children from higher-income homes are charged a monthly premium. Pregnant women who make up to 300 percent of the federal poverty limit are included, as are parents and caretaker relatives who earn up to 200 percent of the poverty limit.

One unusual expansion of the program was covering childless adults—who are not typically covered by any statewide public health program. But a 2007 Wisconsin Health Survey found that of the 265,000 people without health insurance for a year, 90 percent of them were between ages 18 and 64. Of those, nearly 80,000 had no children.

The proof of the success of the program is in the numbers. In just two years, more than 200,000 additional children, parents and pregnant women had health care coverage. An additional 52,000 low-income adults received coverage through BadgerCare Plus. Funding for this program came from combining many federal and state revenue streams, such as Medicaid, S-CHIP, Healthy Start, Medicaid waivers, disproportionate share hospital payments, a federal State Health Access Program grant and state general funds.

Rob Hamilton, executive assistant to the Wisconsin Medicaid director, said at the same time coverage was expanding, there were intense efforts to rein in costs. The program developed a pay-for-performance initiative and mandatory health needs assessments upon enrollment. It also set up a Clinical Advisory Committee on Health and Emerging Technology to recommend benefits for childless adults.

Hamilton said. “At the same time we’re covering a lot of people, we’re using HMOs to cover them,” Hamilton said. “There’s a lot of cost containment going on.”

“Part of it, too, is increasing the quality of the health care being provided,” Henderson added. “If we’re covering more people and addressing what their real health needs are, in the end that will cost us less. Especially with children, if we get them covered early, that will cost us less in the long run.”

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