The BadgerCare Plus Core Plan

1. 1 The BadgerCare Plus Core Plan April 23, 2009

2. 2 Agenda ForwardHealth and ACCESS BadgerCare Plus for Children and Families BadgerCare Plus Core Plan Enrollment Community Partners

3. 3 ForwardHealth Health and Nutrition Programs Health Care Programs: BadgerCare Plus, Medicaid, Chronic Disease Program, Wisconsin Well Woman, Family Planning Waiver, Long-Term Care Prescription Drug Programs: SeniorCare, BadgerRx Gold, Medicare Part D Nutrition Programs: FoodShare, WIC, Free and Reduced Price Lunch, Emergency Food Assistance, Elderly Nutrition, Commodity Supplemental Other Programs and ACCESS dhs.wisconsin.gov/forwardhealth

4. 4 Am I Eligible Tool Simple 10-15 minute screening Shows what benefits families may be eligible to receive: BadgerCare Plus FoodShare Family Planning Waiver Heating Assistance Tax Credits WIC And more! Personalized results and next steps for applying

5. 5 BadgerCare Plus for Children and Families In 14 months, 129,023 individuals have become BadgerCare Plus members, including 80,845 kids. Public Health Departments played a key role in helping families enroll in the program

6. 6 BadgerCare Plus Core Plan Is for low-income adults with no dependent children Is for individuals who are not pregnant, disabled, or qualified for any other Medicaid, Medicare or SCHIP program. Will provide access to basic health care services, including primary and preventive care and some generic drugs Enroll at access.wi.gov No paper applications! Income-eligible adults, from age 19 through 64 who do not have children or do not have dependent children under age 19 living with them, may be able to enroll Income-eligible adults, from age 19 through 64 who do not have children or do not have dependent children under age 19 living with them, may be able to enroll

7. 7 Applying for the Core Plan Apply online at access.wi.gov The BC+ Core Plan has a four step enrollment process: Application Health Survey (Health Needs Assessment) HMO Selection Payment If you are assisting with a Core Plan application and the individual has a question that you cannot answer, they can call 800-291-2002

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9. 9 BadgerCare Plus Core Plan Program Design Eligibility Requirements Payment of an annual application processing fee of $60 or $75 (depending on HMO selection) Income up to 200% of the Federal Poverty Level (FPL) $20,800 annual income for single person (~$10/hour) $28,000 annual income for married couple (~13.46/hour for both) Reporting requirements Move out of state, turn 65, change living arrangement, death, or become eligible for BC+, Medicaid or Medicare. Federal Requirement: Not covered by private health insurance for the previous 12 months No access to employer-sponsored health insurance for the previous 12 months

10. 10 Cost Sharing Application Processing Fee (non-refundable) Co-Payments

11. 11 Enrollment Requirements Managed Care Delivery Model (HMO) The BadgerCare Plus Core Plan for Childless Adults will be delivered through HMOs Participants will select a HMO at the time of application (with 90 days to change their choice) Lower application fee for Tier 1 selection (Effective date of tiers TBD) Eligibility and HMO enrollment begin dates are linked – begins after selection on the next 1st or 15th of month Health Survey Physical Exam (first year requirement) Failure to obtain = loss of eligibility for 6 months (with good cause exemptions) HMOs are required to provide access for exams to avoid penalty This requirement is unique among state Medicaid programs For the first time in the history of any Medicaid expansion program in the nation, Wisconsin’s Childless Adults program will require a member to receive a comprehensive exam as a condition of eligibility, meaning that if a member fails to get an exam within their first year in the program, s/he will be subject to a period of ineligibility. The Department will be collecting health information regarding a member’s health in order incorporate evidence-based medicine into the program design. Since the physical exam is a condition of eligibility, DHS wants to ensure members have access to and receive their comprehensive exams. For the first time in the history of any Medicaid expansion program in the nation, Wisconsin’s Childless Adults program will require a member to receive a comprehensive exam as a condition of eligibility, meaning that if a member fails to get an exam within their first year in the program, s/he will be subject to a period of ineligibility. The Department will be collecting health information regarding a member’s health in order incorporate evidence-based medicine into the program design. Since the physical exam is a condition of eligibility, DHS wants to ensure members have access to and receive their comprehensive exams.

12. 12 BadgerCare Plus Core Plan Covered Services The BadgerCare Plus Core Plan will cover these services: Doctor visits Hospital services Emergency room visits Emergency ambulance rides Emergency dental services Physical therapy Occupational therapy Durable medical equipment Speech therapy Cardiac rehabilitation Dialysis/kidney-related services Some disposable medical supplies Chiropractic Services (effective July 1, 2009) Generic and some brand name prescription drugs **For More Information See Covered Services Handout**

13. 13 The BadgerCare Plus Core Plan does not cover these services: Non-emergency dental services Hearing services Routine vision exams Home health care Hospice Nursing home care Podiatry Non-emergency transportation Inpatient mental health/substance abuse treatment Reproductive health services (These services are covered by the Family Planning Waiver.) BadgerCare Plus Core Plan Covered Services

14. 14 The Enrollment Services Center Applications and other interactions for adults with no dependent children will be processed centrally by the Enrollment Services Center (ESC) The ESC will be comprised of a combination of state and vendor staff – the vendor involved is Automated Health Services (AHS).

15. 15 Community Access Points Gateway to health and nutrition programs for WI residents In-person, individualized help understanding and applying for BadgerCare Plus, FoodShare and other programs To become a community partner, go to badgercareplus.org/partners

16. 16 Claire Smith Senior Communications Specialist Division of Health Care Access and Accountability Wisconsin Department of Health Services 608-266-1334 claire.smith@wi.gov