Milwaukee BC Enrollment Task Force

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Milwaukee BC Enrollment Task Force

• June 4, 2008

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Meeting Agenda

• Welcome Introduce New Members
• Review Summary of April Meeting
• Review of Task Force Charge and Progress
• Words of Appreciation from Secretary Timberlake
• Update on Enrollment Numbers/Cover the Uninsured
  Week
• Status of Childless Adults
• Premium Process Overview
• County Modernization Overview
• Feedback and questions from Members

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Prior Meeting Issue Follow Up

• Need additional information/clarity on BC
  Correspondence
• Workgroup formed to prioritize changes
• Need more information on premiums
• Reviewed process with County
• State presentation to task force today
• Premium payers - 16,100 adults, 7,400 children
• Access concerns
• Survey circulated to solicit changes
• Permanent grandfathering for those kept on
  standard plan?
• Looking at ways we can adjust the formulary may
  require administrative and legislative changes

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Prior Meeting Issue Follow Up

• Ensure Partners know County process
• Additional trainings
• Brown Bag for referral sites
• Libraries
• Worked w/City librarian - Posters at each site
• Faith Community Outreach
• Met with MICAH
• Met w/ Lutheran ministers enrollment at 2 sites
• MICAH reps met w/ Catholic Baptist ministers
• Faith Partnership Network new enrollment sites

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Review Task Force ChargeCommittee Goal

• To bring together key stakeholders in Milwaukee
  to implement a comprehensive BadgerCare Plus
  enrollment strategy.
• Strengthen existing efforts
• Seek additional opportunities and resources
• Ensure all stakeholders are aware and invested

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Committee Charge Phase I Scope

• Objectives Phase 1 (December 2007 May 2008)
• Provide feedback on outreach strategies to the
  DHFS and Milwaukee County prior to the
  implementation of BadgerCare Plus
• Identify resources for outreach
• Actively participate in the outreach efforts as
  appropriate
• Provide periodic feedback on outreach efforts
  once BadgerCare Plus is implemented
• Track issues that come up that are relevant to
  Phase 2.
• Form subgroups as needed to address targeted
  issues.

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Committee Charge Phase II Scope

• Objectives Phase 2 (June 2008 - March 2009)
• Continue to monitor and modify outreach strategy
  as appropriate
• Modify enrollment strategy for Childless Adults
  Implementation (January, 2009)
• Identify systemic issues that may contribute to
  gaps in coverage or barriers to enrollment
• Determine if there is a need for continuation of
  any aspects of the task forces work beyond March
  2009.

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BC Enrollment Since Feb 1

• Statewide enrollment 552,085
• Increase 68,166
• Children 44,260 (65)
• Standard Plan 59,899 (88)
• MKE County 153,517
• Increase 10,932
• Children 8,255 (76)
• Standard Plan 10,318 (94)

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Community Partner Applications

• To date, 25 Milwaukee Area Partners have signed
  up to be a Community Access Point
• 1067 Full BC Applications
• 274 Express Enrollment for pregnant women
• 242 Express Enrollment for Children lt 150
• Statewide1747 full apps, 1382 EEP, 330 EEC

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State Processed Applications

• DHFS has dedicated an unprecedented amount of
  time and money to helping Milwaukee County
  process applications.
• To date we have processed over 1,600 applications
  and helped address 100 outstanding appeals. We
  have assigned 14.0 FTE to Milwaukee and will
  continue to do so to ensure that everyone in
  Milwaukee has access to the program.
• We plan to add hospitals to the list of partners
  processed by the CAPO in near future.

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Outcomes from Cover the Uninsured Week
Activities (Apr 28- May 2)

• Provider Advocate Training Event
• Over 50 participants, positive evaluations
• Channel 4 Phone Bank
• 119 calls, all phones busy for the full hour
• 140 referrals 30 GAMP, 16 BC
• Enrollment Day
• 12 Sites 50 BC application/ 11 GAMP
• Approx 100 enrolled
• 139 application during CTUW (38 over prev week)

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Outcomes from Cover the Uninsured Week
Activities (Apr 28- May 2)

• Prayer Breakfast
• 50-60 participants
• Public Awareness/Promotion
• Phase 2 Ad campaign on WTMJ, WISN, WCTV
• Governors press conference
• Morning Talk Show
• Bolton Article

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Cover the Uninsured Week Apr 28- May 2 Suggested
Improvements for 2009

• Follow up trainings for specific topics/webcast
  trainings
• Expand hours/channels for the phone bank
• Target fewer locations for Enrollment Day and
  increase outreach
• Refocus end of week event as a celebration
  award outreach efforts
• Broader press release, get coverage in community
  papers, seek editorial

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Secretary Timberlake
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Overview of Premium Policy and Process

• Presented by
• Angela Dombrowicki
• DHFS/DHCAA/BEM
• Phone [phone]
• Email angela.dombrowicki_at_wi.gov

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Who is required to pay premiums?

• There are 4 groups that are required to pay
  premiums under BadgerCare Plus
• Most children with income above 200 of the
  federal poverty level (FPL).
• Parents and caretaker relatives with income
  between 150 and 200 FPL.
• Certain parents and caretaker relatives who are
  self-employed with incomes above 200 FPL.
• Former BadgerCare recipient parents who were
  paying premiums in January 2008 and are eligible
  for BC because they are in transitional
  grandfathering status.

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Who does NOT have to pay premiums?

• Children with family income at or below 200 FPL
• Children with family income at or below 300 FPL
  who are verified members of an American Indian
  tribe or an Alaskan Native
• Pregnant women age 19 and above
• Pregnant women under age 19 with income at or
  below 300 FPL
• Youths exiting out-of-home care  
• Children who have met a BC deductible, during
  the remainder of the deductible period
• Children and caretaker relatives in a BC
  Extension
• Parents during the one year of Transitional
  coverage and who did not owe a premium in January
  2008
• Continuously Eligible Newborns
• Persons who are members of families receiving BC
  benefits, but who are individually certified for
  EBD Medicaid, Well Woman Care, Family Planning
  Services or Emergency Services Medicaid, are not
  charged a BC premium

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How is the premium amount determined?

• Premiums are calculated using a polynomial
  equation that is based on the average per member,
  per month cost.
• Premiums are calculated individually and then
  added up to determine the BC group premium
  amount.
• Within the BC test group, there could be
  individuals with no premium at the same time
  other individuals will have to pay a premium.

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How much are the premiums?

• Premiums are based on sliding income scale.
• A minimum premium of 10 per person is required
  for all individuals subject to the premium
  requirement.
• Premium amounts range from 10 to the full per
  member, per month cost. Currently for a child,
  that full premium is 90.74. Adults premiums
  could go as high as 286, but the 5 cap prevents
  anyone paying that much.

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Verification Checklist Letter

• Once an application is processed, a verification
  checklist letter is mailed to the customer with a
  list of items that must be verified before
  eligibility can be determined.
• This is the first information the customer
  receives informing him/her that a premium is
  owed. However, the exact amount of the premium
  cannot be determined until verification of the
  income is received.
• Note There are plans to improve the language in
  the verification checklist when we move to phase
  2 of notice redesign.

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Initial Premium Payment Process

• Initial premium payments must be paid to the
  local agency before eligibility is confirmed and
  the members are enrolled.
• The agency must provide the customer with the
  initial payment coupon.
• Once the premium is paid, eligibility can be
  confirmed and the customer will receive a notice
  of decision with information about the premium
  amount and for whom the premium must be paid each
  month.

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PremiumCoupon
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CARES Notices and Premiums
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Update on Childless Adults
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Core Benefit
BADGERCARE

• Access to basic health care service
• Benefits designed as HMO benefit
• Physician Services Primary,preventative care,
  chronic disease mgmt.
• Diagnostic Services
• Inpatient stays limited outpatient visits
• Therapies (limited number)
• Durable medical equipment
• Dental services, limited for emergency services
  only
• Emergency outpatient
• Fee-for-Service components
• County-based mental health and substance abuse
• Family planning
• Generic Drugs and OTC (BadgerRx Gold for brand
  name drugs)

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Core Plus Benefit
BADGERCARE

• Buy-up option (employer, self employed worker,
  other individual, counties and others)
• Allows employers to contribute to their
  employees healthcare
• In addition to Core Benefits
• Comprehensive dental services
• Chiropractic services
• Vision
• Outpatient mental health sub. abuse services
  (20 / year)
• About 73 per month

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Cost Sharing
BADGERCARE

• Application Fee and Copayment
• No premiums

• Nominal co-payments range from 0.50 - 3
• Co-payments are waived for preventive services
• 20 monthly cost-sharing cap for generic drugs
  (5 per prescription)
• Cost-sharing will be capped consistent with the
  Standard Plan

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CMS Discussion Recap
BADGERCARE

• May 8th 2008 met with Herb Kuhn, the acting
  Director for the Center for Medicaid and State
  Operations (CMSO) , other CMSO managers and staff
• Presented BC Plus for Childless Adult Proposal
• Focused on program design and budget neutrality
• Overall, the proposal was well received by CMS
• CMS was very interested in many of the innovative
  policies incorporated into the proposal

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Budget Neutrality
BADGERCARE

• Budget Neutrality will need the DHHS Secretarys
  approval and OMB approval
• Wisconsin proposed offsetting federal costs by
  utilizing the States Disproportionate Share
  Hospital (DSH) funding and diverted births from
  Family Planning services provided
• CMS reported that it was unprecedented to use
  savings from one demonstration waiver to fund
  another thus could present an obstacle to OMB
  approval
• Utilizing only DSH funding eliminates the need to
  cap spending for other populations in the
  Medicaid program

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BADGERCARE
CLA Childless Adults
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HMO Enrollment Begin Date
BADGERCARE

• Childless Adults Core Plus Benefit Plan will be
  delivered through managed care plans
• Childless Adults will select HMO at the time of
  application (with 90 days to change their choice)
• Without a Fee-For-Service component, the
  eligibility and HMO enrollment begin dates are
  linked
• Enrollment / dis-enrollment information to HMOs
  can be sent same night as confirmation
• Payments can be prorated (daily, weekly,
  bi-weekly, monthly)

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HMO Enrollment Begin Date
BADGERCARE
(Continued)

• Eligibility / Enrollment date the 1st or 15th
  day of the month after eligibility determination
• Prorated capitation payment to HMO days in
  month left in month / capitation rate / number of
  days in month

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Workgroup Progress Recommendation Review
BADGERCARE

• Benefits Cost Sharing
• Benefits Cost Sharing
• Dental Benefit Administration
• Pharmacy Benefit Design
• Clinical Advisory Committee on Health and
  Emerging Technology (CACHET)
• Rate Setting

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Workgroup Progress Recommendation Review
BADGERCARE
(Continued)

• Enrollment Eligibility
• All Applications Renewals Done Through Web or
  Telephone (no mail-in/paper)
• BadgerChoice Support Center RFP will be published
  soon
• For eligible women, ages 19 to 44, Family
  Planning Waiver eligibility (and benefits) will
  be determined and provided separately from the
  BCPlus for Childless Adults. We will enroll these
  women in the FPW program at the same time
• Childless Adults will be eligible until annual
  renewal with the only reasons for their
  BadgerCare Plus closing
• Left Wisconsin,
• Enrolled in Medicare or Medicaid/BadgerCare Plus
  (pregnant, parent, disabled, elderly, etc.),
• Obtained health insurance coverage, or
• Died.

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Workgroup Progress Recommendation Review
BADGERCARE
(Continued)

• Enrollment Eligibility (continued)
• Health Needs Assessment required at application
  and renewal
• Medicaid Emergency Services for Non-qualifying
  Immigrants is not available to this population
  because of the BadgerCare Plus Childless Adults
  benefits prospective nature and health care
  delivery mechanism (managed care)
• Electronic payment of the enrollment fee with a
  credit/debit card or using an electronic check
  will be accommodated. (We will then expand for
  Medicaid, BadgerCare Plus and SeniorCare)

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County Modernization Update
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Feedback from Taskforce Members

• Next Meeting
• Contact for questions
• Audra Brennan MA Policy Liaison/SE WI
• BrennAD_at_dhfs.state.wi.us 414-227-4317