Administrative Simplification Strategies to Increase Coverage BadgerCare Plus

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Administrative Simplification Strategies to
Increase Coverage BadgerCare Plus
Angela Dombrowicki Wisconsin Department of Health
Services Presentation to the Minnesota Senate
Health Care Access Commission December 1, 2008
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Topics Presented

• Overview of BadgerCare Plus
• Enrollment Results
• Administrative Simplification Strategies
• Eligibility Policy Changes
• Electronic Employer Verification of Health
  Insurance (EVHI)
• On-line applications (ACCESS)

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Overview of BadgerCare Plus

• Began in February 2008
• Includes all children (children above 300 FPL
  pay full cost)
• Pregnant Women up to 300 FPL
• Parents and caretaker relatives up to 200 FPL
• Certain self-employed parents farmers with
  incomes up to 200 of the FPL (depending on
  depreciation)

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Enrollment Results

• Prior to BC August 2008
  Increase
• Children 309,790
  365,006 55,216
• Parents/Caretakers 158,493 186,390
  27,897
• Pregnant Women 15,636
  17,889 2,253
• Totals 483,919
  569,285 85,366
• 
  
  (17.6)

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Eligibility Policy Changes

• Created one comprehensive program (called
  BadgerCare Plus) by combining SCHIP and other
  Medicaid programs for low-income children and
  families
• Simplified financial and non-financial
  eligibility policies

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Before BadgerCare Plus

Medicaid / BadgerCare / Healthy Start
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Eligibility Policy Changes

• Simplified gross income test
• Only two deductions
• -Earned income of minors disregarded
• -Court-ordered child support obligations

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Eligibility Policy Changes

• Spend down option for pregnant women to 300 of
  the FPL and children ineligible due to health
  insurance access/coverage to 150 FPL.
• Backdating (up to three calendar months) for
  parents and children under 150 FPL and ALL
  pregnant women

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Eligibility Policy Changes

• Alignment with Wisconsin FoodShare policies
• (i.e. reduced reporting policies-only report
  income for BadgerCare Plus if changes occur above
  a certain threshold such as gt150 FPL or gt200
  FPL)

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Employer Verification of Health Insurance (EVHI)

• EVHI is used to determine non-financial
  eligibility of BadgerCare Plus applicants that
  are employed
• If employer pays at least 80 of major medical
  health insurance plan, individuals are not
  eligible to enroll in BadgerCare Plus

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Employer Verification of Health Insurance (EVHI)

• Pre-BadgerCare Plus employer verification process
  was manual and required applicant to obtain
  verification from his or her employer prior to
  eligibility confirmation
• This process deterred many families from applying
  or completing the application process.

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Employer Verification of Health Insurance (EVHI)

• EVHI Database implemented in May of 2008
• Database includes employer health insurance
  information
• Currently updated by local agency staff and EDS
• State is reaching out to employers for up-to-date
  information about health insurance policies
  available to employees

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Employer Verification of Health Insurance (EVHI)

• Benefits of EVHI
• State of Wisconsins goal is to streamline
  process for determining individuals eligibility
  for and enrollment in BadgerCare Plus
• EVHI database designed to be easily accessed by
  local agency staff, State staff and employers

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On-line Applications -ACCESS

• Total Number of Applications 98,596
• Percent of Total Applications 29
• 65,481- Requested FoodShare
• 72,442 -Requested Medicaid BadgerCare Plus
• 21,877- Requested Family Planning Waiver Services

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Why Develop Online Tools?

• Increase program participation
• Make it easier (and more appealing) to apply for
  and maintain benefits
• Improve customer service and satisfaction
• Create a 24 x 7 customer service model
• Provide alternatives to meeting with or calling a
  worker
• Ease workload for local agencies
• Reduce time spent on data entry
• Reduce customer calls
• Improve payment accuracy
• Make it easier for workers to track and process
  changes

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Designing Self-Service Tools

• ACCESS Wisconsin is based on direct input from
  customers and other end-users
• 40 focus groups and design review sessions with
  low-income residents, advocates, and local
  agencies
• People icons
• Friendly, encouraging text at a 4th grade level
• Personalized pages, results and next steps
• Quick, simple, intuitive navigation

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Online Applications ACCESS Wisconsin

• Combined application for FoodShare and
  Medicaid/SCHIP
• Intelligent driver flow minimizes number of
  questions
• Takes 30 to 60 minutes to complete
• Users may save the application and come back
• After e-signing, users get a tracking number,
  printable PDF summary, and initial list of
  verification items

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Electronic Signatures in Wisconsin

• Wisconsin and federal laws permit electronic
  signatures
• E-signature allows real-time application
  submission
• Filing date is set on a given business day before
  430 p.m.

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Other Concerns about Online Applications

• Incomplete applications
• Name, address and signature will set filing date
• 85 percent of applicants opt to complete the rest
  of the application
• Duplicate applications
• 95 percent of applicants submit only one online
  application
• 37 percent are from people who are already open
  for other benefits
• Priority service/expedited issuance
• 23 percent look eligible for expedited issuance
• Fake, fraudulent or error-prone applications
• Wisconsin has not had significant numbers of fake
  or fraudulent applications
• Errors on ACCESS applications were generally the
  same as errors on other applications

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Who is Applying Online?

• Less than 5 percent of applicants indicate that
  they are getting help from someone else
• 79 female, 21 male
• White 76, African-American 15, Hispanic
  4, Asian 2, Other 2
• Households with
• At least one child under age 19 56
• Someone over age 65 3
• Someone with disabilities 13
• Earned income 64
• Unearned income only 8
• No income reported 27

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Check My Benefits (launched 9/05)

• Detailed benefit information, including review
  dates, benefit amount, pending verification items
  and reason codes for denials or closures
• Contact information for the local agency

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Report My Changes (launched 9/06)

• Reporting options are personalized based on
  program requirements
• Changes are automatically assigned to workers for
  processing and new information is available in
  CARES for worker review

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Report My Changes (cont)

• Customers select and report detailed changes on
  specific records from CARES

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Am I Eligible? (launched 08/04)

• Can be completed in 15 minutes
• Screens for many programs at once (FoodShare,
  Medicaid, BadgerCare, SeniorCare, WIC, TEFAP,
  school meals, summer food, Medicare Part D, tax
  credits and home energy assistance)
• Uses first names, 4th-grade language, and people
  icons
• Detailed, personalized results
• Specific next steps for applying

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Where to Learn More

• ACCESS training environment
• http//trn.access.wisconsin.gov
• You can use this version of ACCESS to submit
  sample applications without actually applying for
  benefits
• Monthly usage report
• http//dhfs.wisconsin.gov/em/access/reports/data.h
  tm
• ACCESS handbook for local agencies
• http//emhandbooks.wi.gov/ah
• Questions about ACCESS Wisconsin?
• Autumn.Arnold_at_wisconsin.gov, 608-266-0157

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For Additional Information About BadgerCare Plus

• Contact
• Angela Dombrowicki, Director
• Bureau of Enrollment Management
• Department of Health Services
• 608-266-1935
• Angela.dombrowicki_at_wisconsin.gov