Vol. 12, No. 19
October 17, 2016
Welcome to the HealthWatch Wisconsin Update Newsletter, a bi-monthly publication with exclusive features for members of HealthWatch Wisconsin.
"Corn Maze Eligibility?"
In this issue...
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SAVE THE DATE! 10th Annual HealthWatch WI Conference
When: March 22 & 23, 2017
Where: Madison Masonic Center, Madison
This annual gathering brings together state policy-makers, public health departments, health care providers, and advocates to learn about health coverage policies and practices, and the latest strategies to help guide people to the health care and coverage they need and deserve.
The 10th Annual HealthWatch Wisconsin Conference begins at 1:00pm on Wednesday, March 22 with an afternoon of Back to Basics sessions, centered on health coverage programs impacting Wisconsin children.
The conference continues Thursday March 23 with the very popular Legislative Panel that will discuss the direction of health policy in Wisconsin.
We are excited to be celebrating 10 years! At this year's annual forum, we will hear right from Wisconsin policy makers at a critical time for health care in Wisconsin, as the state budget is being debated and Wisconsin is paying directly for newly enrolled Medicaid recipients.
The state is also struggling with how to reach the remaining uninsured, especially children in underserved areas of the state. It is a great opportunity for health care service providers from around the state to gather and learn the federal and state rules and policies behind both public and private health care coverage programs. Watch your inbox for special registration announcements, discounts, and details, later in October!
There's Still Time: Packers Tickets Prize Drawing is November 4
The next and final Green Bay Packers Ticket Prize Drawing for the 2016-2017 membership year is right around the corner.
Join or Renew your Individual HealthWatch Wisconsin membership by NOON on FRIDAY, NOVEMBER 4 and you could be watching the Green Bay Packers take on the Houston Texans on December 4 at historic Lambeau Field! See registration information below!
With open enrollment for 2017 and Wisconsin in the state's biennial budget year, the world of healthcare coverage and policymaking developments are ramping up! Changes are hard to keep track of, which is why a HealthWatch Wisconsin membership is more valuable than ever.
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Top Story: Insurance Rates in Wisconsin
On October 7, the Wisconsin Office of the Commissioner of Insurance (OCI) released the insurance rates for the plans that will appear in Health Reform's Insurance Marketplace for 2017 coverage. The process actually began months ago, when insurance carriers were required to submit their rates – with increases or decreases - to OCI for review, along with other federally required forms to show compliance with the Affordable Care Act. Several insurers filed their requests as early as June. OCI approved the rates less than one month ahead of the fourth Open Enrollment period, beginning November 1 and running through January 31. These rates are for coverage in 2017.
In its press release, Wisconsin Commissioner Ted Nickel said, "After our review of rates, consumers in Wisconsin will be facing an average 15.88 percent increase, but that is just an average. Consumers in some areas may see increases as high as 30.37 percent. While increases for Wisconsinites are lower than many other states, these rate changes and the recent exiting of numerous national carriers make it even more important for individuals to actively explore their health insurance options to ensure appropriate coverage."
Cost & Corn Maze Eligibility
Commissioner of Insurance Ted Nickel reported the average rate increase for 2017 will be 15.88% for individual plans in the Marketplace. He said rates ranged in premium increases between 5% and 30%. He did not discuss the plans that have decreased premiums.
Health care costs have been an ongoing conversation for us in the Update Newsletter. We've looked at premium costs, out of pocket costs such as first dollar payments (deductibles) that patients are responsible for, and tax subsidies. In an interview with Wisconsin Public Radio's "Central Time," ABC for Health Executive Director Bobby Peterson continued this conversation with host Rob Ferrett, and what it means for consumers.
Peterson said, "Like everything with the ACA, it's a bit complicated. Generally, when the Marketplace first opened up, insurers were offering plans at a lower price, to build up market share. We also need more 'young invincibles' to join the Marketplace to help distribute the expense a bit better. Also, some of the subsidies for insurers have ended so insurers are now 'on their own,' should they be facing losses. All those factors are coming together to create some increases for some consumers."
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Voices & Views: Corn Maze Eligibility
Open Enrollment is Around the Corner: Your WI Navigators
Open Enrollment in Health Reform's Marketplace is just around the corner. Keep these phone numbers handy to better direct people to local, in-person assistance as they shop, compare, and enroll in a Marketplace plan option.
Grant Amount: $998,960
Northwest WI CEP, Inc.
Grant Amount: $306,227
Forest Co. Potawatomi Community
Grant Amount: $33,119
CMS outlines that Navigator grants help support "local, in-person assistance to help consumers navigate, shop, and enroll in the wide variety of Marketplace coverage options."
They also adopt a "no wrong door" policy - meaning, there are multiple paths to an individual's enrollment options - and multiple paths to help with those decisions. While navigators have targeted service areas, individuals are free to call ANY navigator to be directed to assistance. Individuals can apply at the Marketplace and still be assessed for Medicaid eligibility, or apply at the state and have an application forwarded to the Marketplace.
Wisconsin Coverage Connections: "Consumer's Companion" Updated for 2017
This document gives an easy-to-read overview of health reform, including eligibility and enrollment in insurance Marketplaces, information on cost sharing and tax deductions that are available, and a reminder of BadgerCare Plus eligibility. In each edition of the Update newsletter, we share a resource, helpful for those working on access to health care and coverage issues for children. This week, we share the newly updated, in time for Open Enrollment, the "Consumer's Companion to Health Reform."
Also available - an "insert" page that contains both FAQs and a comprehensive list of county consortia offices, available to help with BadgerCare Plus applications and questions.
This four-page document prints easily - we recommend printing a couple and keeping them on hand for easy distribution to families.
The Consumer's Companion is available as part of the "Wisconsin Coverage Connections" project, a collaboration with the Northwest WI CEP, Inc., Workforce Resources, Inc. and Workforce Connections, Inc., the three navigator agencies that will help families with BadgerCare Plus Enrollment. Other collaborators include CESAs 4, 10, 11, & 12, along with ABC for Health, Inc. and ABC for Rural Health, Inc.
Hosted on the HealthWatch Wisconsin website is the "3 Steps Video Library" page, with a growing video library and downloadable resources. This is YOUR place to learn or refresh your understanding of health coverage program rules. Enjoy our fun approach to learning the basics of BadgerCare Plus; we call it our "3 Steps to Health Care Coverage!" We discuss how you, and other professionals assisting families, can help families Apply, Use, and Keep BadgerCare Plus!
The project serves a targeted 27-county service area. Individuals working with families in other parts of the state may call to learn about resources closer to their region.
BadgerCare Plus Enrollment Data - September
BadgerCare Plus enrollment was down, overall, in the month of September. After making slight gains in August, the previous downward trend resumes. Enrollment for both children and childless adults has leveled over the past few months.
We can anticipate, similar to past years, that enrollment may actually start to increase once we enter the fourth Open Enrollment Period in Health Reform's Marketplaces. While BadgerCare Plus is "always open," with no set enrollment period, individuals and families tend to find their way to the program, thanks both in part to carryover from Marketplace advertising, and from the benefits of the "no wrong door policy." Should someone apply for health coverage in the Marketplace at HealthCare.gov, yet be too low of income, they will be assessed for BadgerCare Plus, and their application will be sent to the state (local consortium).
Enrollment in the Medicaid Purchase Plan continues to grow. This unique program remains underused - keep your eyes open for individuals with a disability determination who maintain an ability to perform some work activities. These folks can greatly benefit from this special Medicaid program. Elderly, Blind, Disabled (EBD) Medicaid enrollment continues its gradual enrollment trend of growth.
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More Eligible for Tax Subsidies if Plans are Bought from Marketplace
Health plans are available outside of Health Reform's Marketplaces. While they, too, have to follow many of the provisions of the Affordable Care Act, like covering "Essential Health Benefits," they do not have to offer the same cost savings, mainly, tax subsidies. Such incentives are only available for plans purchased in the Marketplace.
The Centers for Medicare and Medicaid Services (CMS) have issued a new report detailing the number of Americans who have insurance through non-Marketplace plans who they believe would be eligible for tax subsidies. The report was released last week, as CMS was rolling out its new marketing and outreach effort to get more individuals connected to Marketplace plans.
About 2.5 million people with individual or family insurance plans outside of the Marketplace could be eligible for tax subsidies if they bought through the Marketplace. Even more - there are 9 million people who are completely uninsured who may be eligible for subsidies to help them buy Marketplace plans for the first time.
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Special Feature: Analysis of Community Impact Report
In our last Update newsletter, we shared the Wisconsin Hospital Association's "Community Impact Report." This annual document gives Wisconsin hospitals an opportunity to share an example of the contributions they believe they make to the community, understanding that the measure of charity care alone is not sufficient to document commitment to community.
In the "2015 Community Impact Report: Wisconsin Hospitals: Caring for Our Neighbors," providers voluntarily submit examples and stories to show examples of outreach efforts, education, or charitable ways they are supporting their local communities.
As promised, below HealthWatch Wisconsin begins its review the hospital entries in the Community Benefit report. Our analysis provides opportunities to further reduce the amount of uncompensated care. We call our analysis and ways to optimize coverage for patients "Precision Patient Advocacy (TM)."
By reviewing the details of each individual case, such as income, family structure, conditions and work status, immigration status, and tax responsibilities, amongst other items, an advocate or assister is better able to offer the client the best possible options to maximize their coverage opportunities. Due to this detailed examination of that the very least, our hope is that this analysis may stimulates more discussion on how to help patients. Here is our first case review, starting with a brief summary of one story provided in the Community Benefit Report:
A young twenty-something male was suffering dizziness and symptoms that made him nervous about his heart, based on a long-time heart condition. He was unemployed and uninsured, with limited income. A hospital staff person connected him to a financial assistance program that provided, essentially free Emergency Department care, while also facilitating connection to a local free clinic.
Consider the following questions and information that could potentially better connect this young adult to a system of health coverage and care:e facts, clients are correctly connected to a coverage system, not an instance of an excused bill, and even potentially protected from thousands of dollars in medical debt, reduced uncompensated care rates, and hopefully connected to ongoing care and treatment.
While this retrospective review approach by HealthWatch staff could be called back seat driving, we view it as process improvement to keep working to maximize available coverage and preserve scare charity care resources for those most in need.
How young is he? We know he's in his twenties...but early twenties or late? The difference of a few years actually may matter quite a bit. If he is under age 26, he may be eligible to be enrolled on a parent's insurance policie, called "dependent coverage." This would be true whether or not he was married, and whether or not the parent's plan was an employer-sponsored plan or a Marketplace plan, in most cases. He may be a student - that might open doors to school-sponsored insurance options as well.
Was this patient assessed for BadgerCare Plus? With limited income and no current employment this individual may meet the eligibility criteria for either BadgerCare Plus as a "childless adult," (assuming no children or spouse. If there are other family members, we'd need to know how many, if the patient was the tax filer in the household and if he had tax dependents, among other factors.)
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Changes to MACRA
It was just a year and a half ago, in April 2015 that a major piece of bi-partisan legislation, the Medicare and CHIP Reauthorization Act (MACRA), signed into law. The new law replaces fee-for-service payment models with a quality payment program where "value" replaces "volume" as the benchmark. The Health Affairs Blog calls this, "the second most important law to reform the United States health care system after the Social Security Amendments which created Medicare and Medicaid in 1965."
On Friday, the Centers for Medicare and Medicaid Service (CMS) released the final version of its physician "Quality Payment Program" under this MACRA law. It adds flexibility to the program to overhaul how physicians are paid under Medicare.
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Medicare Open Enrollment
According to the Medicare Blog at Medicare.gov, "It's picking season - pumpkins, apples, Halloween candy...and a Medicare health or drug plan!" Medicare Open Enrollment runs October 15 through December 7. Here is some more advice from Medicare.gov:
"Not all health care is created equal, and the doctors, hospitals and facilities you choose can impact your health. Open Enrollment is also a good time to ask yourself whether you're truly satisfied with your medical care. Look for plans with a 5 star performance rating the right expertise and care can make a difference. Remember, even if you're happy with your current plan, these answers might change from year to year, so it's important to take the time to compare. The Medicare Plan Finder makes it easy to compare plans based on all of these factors, so you can pick a plan that meets your needs."
Bookmark It! Outreach Tool Library
Are you working to connect kids to health coverage programs? This week's featured web link will help!
The US Department of Health and Human Services administers the website InsureKidsNow.gov, and calls it one of the "key Connecting Kids to Coverage National Campaign tools for partners and stakeholders to turn to for Medicaid and CHIP outreach and enrollment information, ideas and materials."
InsureKidsNow.gov provides a pleathora of promotional materials, appropriate to use when working with outreach campaigns or educational efforts directed at connecting children to healthcare coverage.
From social media images to print materials and promotional posters, the library of materials encourages "government agencies, community organizations, health care providers, schools and others" to use and adapt the materials. We'd recommend making sure the materials are adapted to read "BadgerCare Plus," Wisconsin's name for the combined Medicaid and CHIP program in the state.
Watch This! Common Reasons for Private Insurance Denials
Insurance companies can no longer deny coverage based on pre-existing conditions. But what are the more common reasons why private insurance claims may be denied? We talk through a few examples in this week's featured "Video Case Tip: Common Reasons for Private Insurance Denials."
Some may not surprise you - consumers cannot misstate facts on an insurance application form. If they do, coverage can be denied. But what about some of the rules surrounding prior authorization? What about plan restrictions? We talk about those examples in this Case Tip. What's the one piece of advice that fits all individuals alike? Read your policy!
Each informative video from our Video Case Tip Library includes links to resources or more information! You can watch these videos at any time; they're on-demand and available wherever there is an internet connection!
3 C's for CYSHCN! "Competency, Capacity, & Coordination"
Ask a Good Question...
I heard that I can still auto-renew my marketplace plan instead of shopping during open enrollment. I also know that I have until the end of open enrollment to change plans if I want to. But isn't there even more time to pick a plan if your insurance company pulls out of the Marketplace?
Get a Good Answer...
Login to the training portal to read the answer to this week's question!
Family Voices Training Schedule for Fall 2016 Announced:
Family Voices of Wisconsin has released their Training Schedule for Fall of 2016.
These events are an opportunity to expand your knowledge of what resources and services are available for children with disabilities and special health care needs; whether you're a healthcare professional or a parent, the trainings cover care from birth all the way through adulthood. Learn about health insurance and how to best use benefits, Medicaid, as well as long-term supports and community resources!
To view the full schedule of events, which run until November 1st, click here!
HealthWatch Wisconsin Coalition Corner
Milwaukee HealthWatch Coalition Members: the October meeting has been re-scheduled for December! Watch your inbox for an agenda as December approaches.
For more information email your local HealthWatch Coalition contact below, or email us
SafetyWeb Network Corner: Rural Wisconsin Initiative
Access to high-quality and affordable healthcare is the overall goal the Rural Wisconsin Initiative hopes to achieve.
On October 11, the Rural Wisconsin Health Cooperative (RWHC) and the Wisconsin Council on Medical Education & Workforce (WCMEW) endorsed a series of package proposals focused on increasing high-quality and affordable healthcare in rural Wisconsin; also known as the Rural Wisconsin Initiative.
WCMEW's official press release states: "The initiative's workforce proposals include:
Funding for rural hospitals that provide training opportunities to advanced-practice clinicians including nurse practitioners and physicians assistants Expansion of graduate medical education opportunities in rural Wisconsin Incentives for creation of rural consortiums for training allied health professionals"
The bill will provide $3.5 million in funding for the objectives listed above, hopefully impacting the lives of the 1.5 million people living in rural parts of Wisconsin.
More on the Safetyweb Project: ABC for Rural Health, Inc. and a group of community partners and experts secured a federal Rural Health Network grant to support the Safetyweb Health Benefits Counseling Network. This project will expand an existing collaboration to implement a health benefits counseling network that integrates new technology solutions to measurably improve access to health coverage and services for patients in Polk County Wisconsin. For more information contact ABC for Rural Health, Inc.'s COO, Mike Rust.
Headlines & Memos
Featured Headlines / Continuation of Past Articles
WI Budget Project blog on the WI Uncompensated Care report:
ObamaCare Sharply Reduces Wisconsin Hospitals' Uncompensated Care
Medical Visits by uninsured declined in Medicaid Expansion states: the importance of expanding MA:
Insurance Coverage of Ambulatory Care Visits in the Last Six Months of 2011-13 and 2014, by Medicaid Expansion States
More on Surprise medical bills:
Providers say CMS Needs to Push Plans Harder to Prevent Surprise Medical Bills
More on EpiPens!
Mylan to pay $465 Million to settle Medicaid claims
For Ripping off Medicaid, EpiPen maker Mylan Pays Feds $465 million
Helping a Few at the Expense of Everyone
More on "justice involved individuals"
Improving Outcomes for Justice-Involved Individuals With Lessons From Veterans Programs
A bit more perspective on the issue of CMS scrutiny of Marketplace premium payments by the American Kidney Foundation
Denying Poor Patients Health Care Coverage Won't Fix Obamacare
Continuation on health care costs (revisiting premium hikes)
Big Pay for Insurers as Premiums Rise and Plans Tighten
Additional Links of Interest
Health Care Law's Beneficiaries Reflect Its Strengths, and Its Faults, New York Times
More Than 1 Million in Obamacare Lose Plans as Insurers Quit, Bloomberg
Medicaid Spending and Enrollment Growth Have Slowed After Initial 2014 Program Expansion, Miami Herald
Feds Publish Guide to Avoiding Missetps in Electronic Medical Records Adoption, Marketplace.org
Association Between the 2014 Medicaid Expansion and US Hospital Finances, JAMA Network
Health Insurance is a Good Buy to Protect Against Significant Financial Risk for a Range of Common Health Conditions, Avalere
Insurance Churning Rates for Low-Income Adults Under Health Reform: Lower Than Expected But Still Harmful for Many, Commonwealth Fund
The Future of the ACA's Exchanges, Health Affairs
Struggling To Stabilize: 3Rs Litigation And The Future Of The ACA Exchanges, Health Affairs
Judge Says State Overreached in Asking Nurses to Give Back Medicaid Payments, Wisconsin State Journal
Mixed Results for Medicare Experiment, JS Online
Why the Final CMS Rule Could Have Been Worse, National Law Review
University of Maryland Medical School Research Finds Health Disparities Hurt Early Childhood Development, Baltimore Sun
How to Get Public Option Benefits Without a Public Option, JAMA Forum
ACA's Little-Noticed Success: Cutting the Uninsured Rate, Wall Street Journal
Et Cetera: Memos & Updates
NEW! New Policies Effective October 3, 2016 Related to Life Insurance and Exemption from Certain Fees, Wisconsin Funeral and Cemetery Aids Program, published August 2016
NEW! BadgerCare Plus Eligibility Handbook, published August 8, 2016 in Release 16-02
NEW! Medicaid Eligibility Handbook (MEH), published Jun. 24, 2016 in Release 16-02
NEW! ACCESS Handbook, published July 11, 2016 in Release 16-01
NEW! Marketplace Handbook, published July 19
FoodShare Handbook, Release 16-01 published May 31, 2016.
Administrator's Memo 14-04, 2015 IM Consortia Administrative Allocation, has been published to the DHS web
16-31: New Copayment Schedule for MyWIChildCare Implementation
16-30: Child Support Cooperation Review Process for WREA Consortium Child Care Workers during Phase 1 Implementation of MyWIChildCare
16-29: Process and System Changes Related to the FoodShare Work Registration Requirements
16-28: Updates to 1095-B Tax Form Administration
16-27: CARES to Transmit Eligibility Information to InterChange in Real Time for Real-Time Eligibility Determinations
16-26: New Software for Accessing Documents in the Electronic Case File
16-25: Federal Fiscal Year 2017 FoodShare Mass Change
16-24: Enhancements to ACCESS for Partners and Providers and to CARES
16-J5: Enhancements to Real-Time Eligibility and Automated Case ProcessingFunctions in CARE Worker Web and ACCESS
15-22 (Amended): New Way to Access Online Reports from CARES
Other ForwardHealth Announcements:
Case Summary to be Sent to Members Renewing Health Care and/or Caretaker Supplement
Beginning on October 8, 2016, members will be sent a case summary along with their health care and/or Caretaker Supplement renewal notices. Sending a summary with the renewal notice is a new process that is being implemented to comply with provisions in the Patient Protection and Affordable Care Act of 2010 (ACA). A case summary will not be sent to a member renewing FoodShare benefits unless the member is renewing health care and/or Caretaker Supplement benefits at the same time. View an example of a case summary and renewal notice that members will be receiving beginning October 8, 2016.
Funeral & Cemetery Aids Program Memos:
Release 16-02: WFCAP Manual
Required Forms for WFCAP Payments, June 13, 2016
16-06 "FoodShare FFY 14 Bonus Funds"
16-05 "Enhanced Federal Funding for Qualifying IM Activities"
16-04 "QUEST/Vault Card Process & Procedures"
2016-39: Medicaid Program Integrity Education Resources Available, Including Continuing Education Courses
2016-38: Targeted Reimbursement Rate Increase for Certain Dental Services Provided in Four Counties
2016-37: Eligibility Information Immediately Available in interChange for Real-Time Eligibility Determinations
2016-36: Upcoming Trainings for the All Patient Refined Diagnosis Related Group System
2016-35: Changes to Billing Policy for Chiropractic Services
2016-34: New and Clarified Policy for the Behavioral Treatment Benefit
2016-33: New Coverage and Prior Authorization Policy for Positioning Seats for use in Motor Vehicles and at Home
Funeral & Cemetery Aids Program Memos:
Release 16-02: WFCAP Manual
Required Forms for WFCAP Payments, June 13, 2016
Tell Us What You Think!
HealthWatch Wisconsin Update readers, we want to hear from you! What do you think of our newsletter? The subject matter? The format? How do you find the material on the HealthWatch Wisconsin Training Site? Do you have any topics you'd like to see or questions you want answered? Please email HealthWatch and let us know!
Support Our Efforts!
Thank you, HealthWatch members, for your support! ABC for Health works hard to ensure that thousands of families in Wisconsin receive the health coverage they need and deserve. What we learn from individuals and families informs the teaching and training we share with HealthWatch Wisconsin members! Keep those families in mind this season and work towards a happier 2016 by supporting ABC for Health in our mission of helping people secure access to health care and coverage. A tax-deductible financial contribution will support direct legal, advocacy, and education services to families in Wisconsin.
Copyright 2016 ABC for Health, Inc. All rights reserved. No reprint without permission.
HealthWatch Wisconsin is a project of ABC for Health, Inc.
Bobby Peterson, Executive Director
Brynne McBride, Chief Operating Officer
Ryan Stasell, Executive Assistant
Matt Keller, HWW Membership Coordinator
Special thanks to ABC for Health staff for their contributions to this Update Newsletter