Practically Speaking

Kyle and her husband moved to Brookfield in 1986. She became active in local politics and started blogging in 2004. Her focus is primarily on local issues but often includes state and national topics, too. Kyle looks at things from the taxpayers' perspective in a creative, yet down to earth way, addressing them from a practical point of view.

Badger Care, for low income?

BadgerCare Plus off to a healthy start

State program provides coverage for low-income families

Posted: April 29, 2008

More than 71,000 children and parents in Wisconsin have gotten health insurance in the first six weeks after the state consolidated and simplified the health programs that provide coverage for low-income families.

The increase, which included 13,500 children and parents in Milwaukee County, marks a strong start for Gov. Jim Doyle's initiative to provide access to affordable health insurance to almost every child in Wisconsin.

The initiative, called BadgerCare Plus, entailed a sweeping restructuring of state health programs for low-income families and a statewide push to insure children who have been eligible for coverage but not enrolled in state health programs.

"Our goal with BadgerCare Plus was to get the kids in this state insured," Doyle said in a recent interview. "That was the goal, and we all should feel this has been a great success in its first couple of months."

The state has figures only through February. But the response to the program, launched on Feb. 1, has far exceeded the state's projection that an additional 26,000 to 27,000 children and eligible adults would sign up for BadgerCare Plus in the first 12 to 18 months.

It also could undercut the state's projection that the cost would be offset by streamlining state health programs, expanding the use of health maintenance organizations and the premiums and co-pays paid by families.

"We are going to have to wait a few months and see how this plays out," said Jason Helgerson, the state's Medicaid director.

Helgerson was unapologetic about the initial response despite the projected budget shortfall.

"We have an opportunity to get at the heart of the uninsured problem in this state," he said. "And I think we have a pretty cost-effective way to do it."

More than 60% of the additional cost of BadgerCare Plus will be offset by federal matching funds. Some families also will pay premiums.

Eligible, but not enrolled

An estimated 71,000 children and 360,000 adults in Wisconsin were uninsured at a given point in time in 2006, according to an annual state survey. An estimated 48,000 of those children and 249,000 of those adults were uninsured for a full year.

Roughly half of the uninsured children in the state are eligible for state health programs but not enrolled.

Two of Toy Gooden's children, who have been without insurance for two years, may have been among them.

Her other two children, both disabled, were covered. But Gooden, who works two jobs, had been told her income exceeded the cutoff. She may have been given incorrect information: Her income would have needed to exceed $45,880 for her and her other children not be eligible.

"My income is not even close to that," Gooden said.

She applied for BadgerCare Plus after learning about the program at one of two clinics run by Milwaukee Health Services.

BadgerCare Plus consolidated the state's three health programs for low-income families - Medicaid, Healthy Start and BadgerCare - and simplified enrollment.

The new program also enables families whose children were not eligible for existing state programs to buy health insurance through the state. The cost ranges from $10 to $90.74 a month, or $120 to $1,089 a year, for each child depending on family income.

The cost is subsidized by the state for children in families with incomes from 200% to 300% of the federal poverty level - $41,300 to $63,600 for a family of four. Families with incomes above that pay the full cost of the insurance for their children.

Through February, more than 12,200 children and pregnant women had signed up for the new plan, which offers limited benefits.

Families are not eligible for the plan if an employer pays 80% of the cost of family coverage.

BadgerCare Plus also is not available to children or parents who are illegal immigrants. In general, legal immigrants in the country for less than five years typically are not eligible for benefits.

Making it easier to sign up

The biggest changes under BadgerCare Plus may be what the state has done to simplify the complex rules that determine eligibility and to make it easier for families to apply.

"Wisconsin is a sort of trendsetter there," said Enrique Martinez-Vidal, director of the state coverage initiatives program for AcademyHealth, a policy research organization.

The program's launch also included the most extensive drive in a decade to get eligible children signed up for health insurance.

A series of events, for example, will be held today at sites throughout Milwaukee County.

The state also has put in place a system in which community health centers in Milwaukee can file applications directly to Madison instead of Milwaukee County. It has assigned five people in Madison to handle those applications.

Limited staff at Milwaukee County has long caused problems for families signing up for state health programs.

"It's a world of difference," said Daniel Adams, a social service specialist at Sixteenth Street Community Health Center. "We can actually get through to someone."

Carlo Cervantes, a co-worker, and Adams alone have signed up more than 300 children and adults in BadgerCare Plus, Adams said. That is just at one of the community health center's sites.

The state may assign additional people in Madison to help Milwaukee County with the workload. Helgerson said that making sure that people in Milwaukee County would have access to BadgerCare Plus has been one of the biggest challenges - "if not the biggest challenge."

People also can apply online for BadgerCare Plus. The state had received 12,500 online applications from community health centers and from individuals through February.

"It's a wonderful thing the state did," said Tanya Hudson, benefits coordinator for Milwaukee Health Services. "It's opened the door for a lot of people, and it has made the process less burdensome."

No cuts proposed

The number of children and parents who get health insurance through BadgerCare Plus could continue to increase, although the state expects some people will not pay their monthly premiums and will lose coverage.

The greater numbers will add to the program's cost at a time when the economy is slowing.

Rep. Kitty Rhoades (R-Hudson), co-chair of the Legislature's Joint Finance Committee, said the fiscal implications would depend on the income of people signing up for the program and the premiums the state collects.

"We'll just have to wait and see how this plays out to see if they can achieve the savings they had predicted," she said.

Providing health insurance to healthy children is relatively inexpensive. The biggest Medicaid expense - roughly two-thirds of the state's $5.7 billion budget for Medicaid programs - is providing health care for people who are elderly or disabled.

Doyle acknowledged that shortfall in the budget - now estimated at $652 million in the current two-year budget. But he noted that no one is proposing cuts to BadgerCare Plus.

"It's the right thing to do," he said, "and it's the smartest investment we can make of health care dollars."


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