Child coverage expands in state

from The Milwaukee Journal Sentinel

By GUY BOULTON

Starting today, almost every family in Wisconsin will have access to affordable health insurance for their children.

The insurance will cost $10 to $90.74 a month for each child, depending on family income, and will be available through the state under the new program known as BadgerCare Plus.

The state hopes to enroll 25,000 people in BadgerCare Plus in the first year to year and a half.

"It's a huge step toward providing cost-effective health care coverage for all children in the state," said Jon Peacock, research director for the Wisconsin Council on Children & Families, a statewide advocacy group in Madison.

The new program will consolidate and simplify three existing programs that provide health insurance to low-income families in Wisconsin: Medicaid, Healthy Start and BadgerCare. Those programs now will be known as BadgerCare Plus.

The state estimates that the expanded coverage will cost $50 million over the next 1½ years.

The federal government will pay more than 60% of the cost. In addition, the program will be financed by the premiums paid by families, coupled with efficiencies attained by the expanded use of health maintenance organizations and administrative savings. Families with incomes above 300% of the federal poverty level - $63,600 for a family of four - will pay the full cost of the health insurance for their children: $1,089 a year for each child.

The cost will be lower for children in families with incomes that fall between 200% and 300% of the federal poverty level. Parents and children in households with incomes below that are eligible for health insurance through the state at no cost.

In most parts of the state, children will get basic coverage through an HMO run by private companies that contract with the state. The coverage will have some co-pays, including a $60 charge for inappropriate emergency room visits, and will provide for only generic prescription drugs. It also will have limited benefits, similar to commercial plans, for behavioral health.

BadgerCare Plus also will change the way the state determines eligibility for farmers and people who are self-employed, enabling more families to qualify for subsidized coverage for their children, or free care for the family, depending on their incomes.
Quicker, simpler

The state estimates that 48,000 children in Wisconsin were uninsured for the full year and 71,000 childrenwere uninsured at any given point in time in 2006. An estimated two-thirds of those children wereeligible for state health programs before BadgerCare Plus.

One of the key goals of BadgerCare Plus is to simplify the programs.

"We have tried to take the complexity out of the program as much as possible for people enrolling," said Jason Helgerson, administrator of the state's Division of Health Care Financing, who will oversee BadgerCare Plus.

Here's an example of that complexity: A mother could get coverage for herself and children under 6 - but not for children who were older. As a result, some children within the same family would have health insurance while others would not.

Under the previous programs, the state estimates that there were 22 categories for determining eligibility.

Under BadgerCare Plus, there will be three."It seemed to me that there had to be real savings there if you streamlined this and made it into a single state health insurance plan," said Gov. Jim Doyle, who first proposed BadgerCare Plus in 2006.

One of the biggest changes under the new program is Express Enrollment.

Children in families with household incomes of 150% or less of the federal poverty level - less than $21,000 for a parent and a child, for example - will be immediately enrolled upon applying for BadgerCare Plus. The families will then have the balance of that month and the next month to provide the needed documents.

"You walk away with a card right after your enrollment," Helgerson said.

People also will be able to apply for BadgerCare Plus online.

Even with the changes, BadgerCare Plus will have its share of complexity. The manual on the program is more than 300 pages. And the program's introduction will inevitably bring some problems.

"Whenever you change anything of this scale, you are going to have glitches," Helgerson said.

The program's rollout includes $447,142 in grants to community organizations to help explain the new program and to process applications. Anthem Blue Cross and Blue Shield Foundation gave the state $300,000 to help fund the grants.

"We really are trying to do everything we can to get the word out to as many people as possible," said Audra Brennan, who was hired by the state four months ago to be the liaison for southeast Wisconsin.

The unknown is how many families will buy insurance for their children through BadgerCare Plus.

"We want people to know that this is a very inexpensive way to get their children insured," Doyle said. "To me, that is the biggest challenge in the coming months - to do the outreach."
Some exceptions

While BadgerCare Plus will make affordable health insurance available to almost every child in the state, the program won't make it available to all.

"In the big picture, it's a step in the right direction," said Bobby Peterson, a lawyer with ABC for Health, a public interest law firm based in Madison. "Some families are going to face challenges in understanding the program and getting the coverage they need."

Parents whose employer pays 80% of the cost of family coverage, for instance, are not eligible for the program. That could be a problem for low-wage workers whose employers offer only a health plan with a high deductible.

"That's something we are going to look at going forward," Helgerson said.

BadgerCare Plus also will not cover children who are illegal immigrants. And legal immigrants must wait five years before they are eligible. (Children born in the United States are citizens and are eligible.)

The one exception is pregnant women. The reasoning here is that prenatal care can save money by ensuring the birth of a healthy child who will be a U.S. citizen. The mother loses her coverage with the birth of the child.

"This is a very difficult issue that the country itself has to grapple with," Doyle said. "We are controlled by federal law on this."

The governor said he believes that providing health care to all children, including those who are illegal immigrants, is a moral obligation.

"If a child came into an emergency room who is seriously injured or seriously ill, I can't believe there is anybody in the country who wouldn't say we have to do something about that," Doyle said. "We can't just say, 'I'm sorry. Go back out into the cold. We're mad at your parents.' "

Doyle hopes to expand BadgerCare Plus next year to make health insurance available to low-wage workers who don't have children.

For now, the state's focus is on getting children insured. And state officials believe they've come up with a relatively low-cost way to do that.

"We've done it in a very practical way," said Kevin Hayden, the secretary of the Department of Health and Family Services. "This is a great story for us to celebrate."