Wisconsin has a considerable number of uninsured women and children ranging in hundreds of thousands. Tommy Thompson, the governor and legislature of Wisconsin set out to reduce this number in the late 1990’s. This paper seeks to briefly describe the beginning and enactment of BadgerCare program. It also seeks to demonstrate the evolution and expansion of the program to become BadgerCare Plus. The evolution of eligibility requirements for the program participants will be examined. The paper will also look into the number of residents affected by the expansion of BadgerCare into program into BadgerCare Plus.
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BadgerCare is a family based health care plan in the state of Wisconsin. This program owes its enactment to the governor and legislature Thompson back in 1997. BadgerCare program ensures availability of healthcare to the working poor and uninsured families. The families covered have incomes falling between the current Medicaid limits and 185% of FPL (federal poverty level).This program is financed with both federal Title 19 and Title 21 funding, premiums paid by families with over 150% of FPL incomes and state revenue (Families USA, 2007).
Initially, BadgerCare was planned to be launched on 1st July 1998. However, this was delayed by state and federal officials’ negotiations concerning the structure and financing of the program. The agreement was at last made in January 1999, and later the program commenced on 1st July 1999. During the approval of BadgerCare program, there existed an impasse between federal and state officials. There were two primary impediments to federal endorsement of the program. The first issue was the extent of federal Title 21 funds to be spent for adults. The other issue was whether Title 19 (Medicaid) funds were to be utilized in a non-entitlement program (Wisconsin Council on Children &Families, 1999).
At first, the state proposed to finance BadgerCare with federal funding under Title 21, the Child Health Insurance Program (CHIP). The federal Health Care Financing Administration (HCFA) insisted that the Child Health Insurance Program legislation was the Congress primarily intention of the extension of health care for under-ages. In addition, it contained a very narrow exemption for taking care of adults. The federal Health Care Financing Administration accomplished that majority of the parents proposed covering were not within that exemption. The officials of federal Health Care Financing Administration suggested to the state that the program could be approved if the Medicaid funds and CHIP funding for children were used.
This required a 41% state match for the majority of the parents. Nevertheless, state officials welcomed the suggestion of a hybrid approach. This was due to entitlement state of Medicaid program. It was hard to use it as a part of the funding mix because the BadgerCare legislation openly states that it is not a prerogative program (Leininger, Friedsam, & Dague, 2009).
The negotiations lasted for two years and three months, after which an agreement was reached. The procedure of the compromise outlined by HCFA in August 1998 was to be followed. This accord required federal Title 21 funds to be utilized for children and to some extent, a small division of parents. In general, parents were to be funded under Title 19, with a 41% state match. The agreement allowed the state to ascertain a method of setting minimal income eligibility. The accord accommodated the major concern of those who insisted the program to be non-entitlement. This was done by mandating the state to restrict its financial accountability.
The accord also satisfied a group of people who were concerned about keeping prerogative state of Medicaid. The agreement protected the families in that they were not to be affected by the lowering of income eligibility limit. This meant that the families were not to be removed from the program as long as they met the eligibility criteria that existed when they were first enrolled. A noteworthy aspect of the accord was that the state was allowed to utilize premiums of about 3.5% of family income to capture federal corresponding finances.
BadgerCare was open to parents and children with incomes above 185 percent of the FPL. Registration in the program was fundamentally doing well. In January 2007 about 30,000 children and more than 66,000 parents had been covered by the program. Additionally, enrollment of children in Medicaid had enlarged considerably since BadgerCare program was initiated. The success of the program however did not enroll all the residents in the state of Wisconsin.
Statistics indicated that the state still had a significant number of uninsured residents. Uninsured residents accounted for about 11.5% of the state population below the age of sixty five. Moreover, state investigations indicated a rise in number of uninsured children. To counter the predicament, the governor of Wisconsin Doyle Jim proposed BadgerCare Plus to make the program more affordable to the vast population. This agenda was designed to make health coverage financially reasonable and reachable to all children.
Kaiser commission observes that even in the wake of economic recession, BadgerCare plus program has effectively built upon Medicaid, covering approximately 770,000 residents of the state of Wisconsin. This is approximately 235,000 more than what the program covered when it was initiated back in 2007. BadgerCare plus program has successfully combined the Wisconsin’s three distinctive Medicaid programs for parents, children and expectant women into one complete health coverage program. It has also stretched out eligibility to give a widespread coverage for minors and larger coverage for parents and adults with no children. Implementation of BadgerCare Plus program for parents, children, and pregnant women took place in February 2008. The childless adult expansion was launched about one year later in January 2009.
BadgerCare Plus program operates on a concrete base of employer sponsored health care and Medicaid in Wisconsin. Sixty eight percent of non elderly residents in 2008 had been covered through an employer, in comparison to sixty percent nationwide. Statistics indicate that before the program was initiated, levels of Medicaid eligibility in the state were 185% of FPL (federal poverty level). Notably, levels of coverage for children lagged behind other states. The state of Wisconsin presented a wider coverage for low-income parents. The state of Wisconsin also has a comparatively low uninsured rate compared to other states. About ten percent of the non-elderly residents are uninsured. This is in line with Wisconsin’s objective which is to guarantee that at least ninety eight percent of its residents are covered with an affordable health care.
BadgerCare Plus program has expanded to cover more of Wisconsin residents. The program has evolved to cover the children, parents and pregnant women and grown-ups without children. The eligibility requirements have also evolved to cover new participants in the program. Uninsured children under nineteen years of age have been covered regardless of financial capability of their families. The program provides incentives to children with family income up to 300% FPL. Those above 300% pay the full cost while those with less than 200% FPL are not requisite to pay their premium. Notably, new participants in BadgerCare Plus program are the legal immigrant children.
These children were in the past unable to acquire Medicaid coverage until they lived in United States for five years. Statistics indicate that over 445,000 children were already covered in April 2010. This is 135,000 more than those enrolled under Medicaid before BadgerCare Plus began (Friedsam, Leininger, & Bergum, 2009).
BadgerCare Plus also stretched out coverage for parents with incomes up to federal poverty level of 200%. These are the parents who lacked access to employer sponsored health insurance for the past twelve months. In addition those with incomes below 150% federal poverty level do not pay a premium. For those with less than 300% FPL have their premiums limited at 5% of their income. Evolution of eligibility requirements of BadgerCare Plus is notable for pregnant women and young adults. Expectant mothers with family income of 300% Federal Poverty Level are covered with no cost sharing and premium requirements.
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Young adults taking care of themselves, and who are not under foster care are also eligible. Statistics indicate that as of April 2010 about 86,500 extra parents were covered under Medicaid. In addition, approximately 3,200 added expectant women were covered before the program begun. The evolution of the eligibility requirements encouraged new participants to be included in the program. The program enlarged the coverage to childless adults earning up to 200% Federal Poverty Level. Initially, this group had been ineligible for the program, starting with those already registered in county-financed medical programs. Other childless adults who met the financial prerequisite, and had not been covered privately in the past one year also became eligible. More than 60,000 childless adults were already enrolled in the plan as of April 2010.
BadgerCare Plus provides two special advantage plans for families. These include the benchmark plan and the standard plan. The standard plan covers families with incomes less than 200% federal poverty level. This includes the same set of complete covered services as was offered in the preceding Medicaid programs for families. Families with more than 200% federal poverty level are covered in the benchmark plan. The later is designed after the state’s biggest low-cost commercial health insurance plan (Witgert, 2009).
The state of Wisconsin has sought to ease its enrollment and outreach process for the healthcare program. In addition to widening the coverage BadgerCare Plus, Wisconsin has also sought to assist and abridge enrollment and restitution of the program. The state has joined with community-based organizations (CBOs) and health care practitioners to recognize and sign up deserving families and children. Furthermore, CBOs can routinely register children with family income falling below 250% Federal Poverty Level, and expectant mothers with family income falling below 300%.
The state has also made the registration process to be easy by forming a centralized and electronic application system. The electronic system is completely incorporated with an online tool. The online tool let individuals and families to establish their eligibility for diverse programs. It also allows online applications for benefits, and checking the status of application. Health coverage can be applied electronically and some coverage information is automatically confirmed.
An increased demand for coverage and a budget crisis in October 2009 were as a result of economic recession. This made the state to limit the number of BadgerCare plus Plan joiners. Roughly 30,000 applicants who were qualified for the program had been kept waiting. In attempt to take care of those who had been kept waiting, Governor Doyle suggested the BadgerCare plus basic plan. The proposed plan would let those waiting to purchase a health plan at full-cost. Consequently, the law forming this new program was enacted on 30th April 2009. Compared to the core plan, the basic plan provides more limited advantages. It comprises of one hospital visit, ten physician visits, and five outpatient visits annually. In addition, the participant is entitled to access general prescription drugs. The basic plan is associated with a premium of $130 per month, and registration commenced on 1st June 2010 with coverage starting in July 2010.
Kaiser commission considers BadgerCare plus as a lesson for other states and the national health reorganization. Many states continue to struggle in order to preserve the present health care programs. This has proved difficult due to the widening demand for coverage and the current economic recession. Nevertheless, the state of Wisconsin keeps on expanding its health coverage to almost all its residents. BadgerCare plus program can be applied as a good example of how coverage expansions can grow on Medicaid to present a concrete platform for national health reorganization. In this program, parents, children, childless adults and pregnant women of different financial capabilities are all registered under one rationalized program. The organized program can operate even during the wake of economic recession. In conclusion, BadgerCare plus program is an organized masterpiece that should motivate any administrator in healthcare.
Families USA. (2007). Wisconsin’s 2007 Health Care Proposal: BadgerCare Plus. Web.
Friedsam, D., Leininger, L., & Bergum, A. (2009). Wisconsin’s BadgerCare Plus Coverage Expansion and Simplification: Early Data on Program Impact. Web.
Leininger, L. J., Friedsam, D., & Dague, L. (2009). Wisconsin’s BadgerCare Plus Reform:Impact on Low-Income Families’Enrollment and Retention . Web.
The Kaiser Commission. (2010). Wisconsin’s BadgerCare Plus Program: Moving Forward on Health Reform Amid a Recession. Web.
Wisconsin Council on Children &Families. (1999). Wisconsin’s BadgerCare Program. Web.
Witgert, K. (2009). BadgerCare Plus: Medicaid and Subsidies Under One Umbrella. Web.