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HealthWatch Wisconsin's

BadgerCare+ Bulletin

In This Issue

Volume 1, Number 2
April 2011
HWW Logo

BadgerCare+ Bulletin is a publication of HealthWatch Wisconsin, a project of ABC for Health, Inc.
Visit us online at www.healthwatchwisconsin.org.

More Chances to Share Your Story with Legislators, DHS!

Both the Joint Finance Committee (JFC) and the Department of Health Services (DHS) are continuing to host public hearings. Attend if you can - these are great opportunities to speak out and let these two groups know just how important BadgerCare and Medicaid are for the people of Wisconsin!

Below is the most recent information we have, as of today, April 8, 2011.
The next two JFC meetings are scheduled for:

  • Monday, April 11 (10am – 6pm). State Fair Park, Expo Center Hall A, West Allis.
  • Wednesday, April 13 (10am – 6pm). Rescheduled for Neenah.  Pickard Civic Auditorium (1275 Tullar Road, Neenah)

For more information on the budget and ideas on what to respond to, check out this page on the HealthWatch Wisconsin website.

The next DHS Town Hall meeting is in Milwaukee and will run well past 5 p.m., so please let everyone know, especially those who have been discouraged by the limited time for the meetings.

Thursday, April 14, 2011
1:00 P.M. – 8:00 P.M.
Zoofari Conference Center
9715 W. Blue Mound Road
Milwaukee, WI 53226

(The Zoofari Conference Center is directly on Blue Mound Road. Do not enter the main zoo entrance)

Future DHS Town Hall meetings should be posted on this page.

HealthWatch Posts Public Hearings Online!

HealthWatch Wisconsin has posted videos of public testimony about the impact of proposed BadgerCare and Medicaid cuts that will affect 1.2 million Wisconsinites covered by these programs. In March, HealthWatch Wisconsin sponsored two days of public hearings during the HealthWatch Wisconsin Annual Conference, drawing hundreds of people to listen, learn, and for some, to share their stories and the stories of their loved ones. HealthWatch Wisconsin staff was on hand to record participants' testimony.

View the videos here

Health Reform Today

One year ago last month, President Obama signed the health reform act into law. Many parts of the law will not go into effect until 2014. To see a full list of the health reform items and a timetable, see this page. Here is a summary of a few important elements of the Act that have already taken effect:

Extension of Dependent Coverage (Now in effect)

Imagine being a recent college graduate without a job. Right after graduation, you find out that your health insurance coverage through your parents' policy has ended. If you need any medical care, you must pay for it out of pocket. Before health reform, this was the situation for many young people. Many health plans would not cover adult children living away from home unless they were students. Many young adults lacked health insurance. Now, after health reform, individuals up to age 26 can remain on their parents' healthcare plans. It does not matter whether or not they are students and whether or not they live with their parents. However, this rule does not apply to people under age 26 who can get their own health insurance at work. For more information, click here.

Prohibition of Exclusions Based on Preexisting Conditions (Now in effect for children; will be in effect for most adults in 2014)

What if you have cancer and you have no health insurance? You will have trouble finding ny coverage. Most insurance companies will not cover your preexisting condition. Like the student example above, many uninsured individuals with health problems cannot find affordable insurance. The new health reform law stops insurers from excluding most children with preexisting health conditions. By 2014, the new law stops insurers from excluding most adults with preexisting conditions as well. For more information, click here.

Insurance policies that are easier to read and understand (Now in effect)

Health insurance plans are not easy to read. But health reform will make them easier to read and understand. Health reform requires insurance companies to use clear, simple language and standardized definitions to explain each plan's benefits and limits. This will make it easier for consumers to compare health insurance plans from different companies.

Restrictions on Lifetime/Annual Limits (Now in effect)

Before health reform, insurance companies often limited the yearly or lifetime medical expenses covered by a policy. This meant the company would stop paying for a person's healthcare expenses if the medical bills passed the coverage limit. If you had a bad car accident and needed many surgeries, you could go over the limit set by your insurance company. After you hit the limit, you would be responsible for all your healthcare expenses. Now, health reform gets rid of the lifetime and annual limits for most policies. For more information, click here.

Express Enrollment Basics

What if you learn that you are pregnant and you have no health insurance? What if you learn that your child needs care for a medical condition but your family is not insured?

The BadgerCare Plus Express Enrollment program might be able to help. Certain pregnant women and children may be able to get immediate health coverage through the Express Enrollment program. Express Enrollment allows qualifying children and pregnant women to gain temporary access to health care services without having to complete the full BadgerCare Plus application and wait to find out if their application is accepted.

Express Enrollment provides temporary coverage. Coverage ends on the last day of the month after the month during which you apply. So, if you apply for Express Enrollment in April, your coverage will last until the last day of May. Coverage will end on the last day of May no matter what day in April you apply.

You can apply for regular BadgerCare Plus while you are covered through Express Enrollment. If your application is accepted, your Express Enrollment will end as soon as your regular BadgerCare Plus coverage starts. If your application is denied, your Express Enrollment coverage will end immediately.

Who Qualifies for Express Enrollment?

You could qualify for Express Enrollment if:
      1) You are a U.S. citizen AND
      2) You are a pregnant women OR a child age 19 or younger AND
      3) You meet the financial requirements below.

Financial requirements for pregnant women:

To qualify for Express Enrollment, pregnant women must have a family income at or below 300% of the federal poverty level (FPL). To determine your FPL percentage category, go to ABC's FPL Calculator.

Financial requirements for children:

Family income limits for eligibility depend on the age of the child.

Child's Age Family income limit
Less than 1 year old 300% of the FPL
Age 1 to 5 185% of the FPL
Age 6 to 18 150% of the FPL

Terms to Know

Preexisting Condition: an illness or a medical condition a doctor diagnosed or treated in the time period before an individual's insurance was in effect. Under Wisconsin law, the presence of symptoms of a disease or a physical condition are included in the definition of a preexisting condition, under certain circumstances. If an "ordinary and prudent person" would seek out a doctor's diagnosis or treatment for the symptoms, then it is assumed that the individual experiencing the symptoms has a preexisting condition, even if she didn't seek care.

Federal Poverty Level (FPL): a calculation of a family's household size and gross monthly income to determine financial eligibility for certain federal and state programs. The calculations, refigured each year by the U.S. Department of Health and Human Services, use weighted averages of federal poverty thresholds. The information is published each year in the Federal Register.

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