Administrative Simplification Strategies to Increase Coverage BadgerCare Plus

1. 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

2. 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)

3. 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)

4. 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%)

5. 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

6. Before BadgerCare Plus Medicaid / BadgerCare / Healthy Start

8. Eligibility Policy Changes • Simplified gross income test • Only two deductions -Earned income of minors disregarded -Court-ordered child support obligations

9. 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

10. 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 >150% FPL or >200% FPL)

11. 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

12. 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.

13. 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

14. Employer Verification of Health Insurance (EVHI) • Benefits of EVHI • State of Wisconsin’s goal is to streamline process for determining individual’s eligibility for and enrollment in BadgerCare Plus • EVHI database designed to be easily accessed by local agency staff, State staff and employers

15. 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

16. 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

17. 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

18. 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

19. 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 4:30 p.m.

20. 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

21. 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%

22. 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

23. 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

24. Report My Changes (con’t) • Customers select and report detailed changes on specific records from CARES

25. 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

26. 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.htm • ACCESS handbook for local agencies • http://emhandbooks.wi.gov/ah • Questions about ACCESS Wisconsin? • Autumn.Arnold@wisconsin.gov, 608-266-0157

27. For Additional Information About BadgerCare Plus Contact: Angela Dombrowicki, Director Bureau of Enrollment Management Department of Health Services 608-266-1935 Angela.dombrowicki@wisconsin.gov