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On Friday, June 24, 2016, ABC for Rural Health, Inc. will hold a training at the Health Department in the Polk County Government Center in Balsam Lake. The event, called "Who's Whose?" will begin at 10:00 AM and end at Noon.
This is a training for professionals and other assisters who help families with health care coverage. In the headline presentation, we will focus on how to quickly and confidently build family, household, and fiscal test groups for BadgerCare, Medicaid and the Marketplace.
While building application relationships for the Marketplace is relatively straightforward, BadgerCare and Medicaid group-building can be confusing. We will review how fiscal responsibility is determined, demonstrate how to use the BadgerCare Plus MAGI Flowchart, and provide you with take-home materials to streamline your work with families. Since the Medicaid Purchase Plan has special and complicated rules for household relationships and eligibility, we will also provide a detailed orientation to MAPP.
We will also provide brief sessions on a few health care coverage topics that have been in the news lately:Medicaid and the Marketplace for incarcerated personsMental Health Parity update with some short tips on how to spot issues and raise concerns New rules for Medicaid HMO’s.
Please contact Mike Rust at 715 485 8525 to RSVP, ask questions or get directions.
We at ABC for Health and HealthWatch Wisconsin would like to express our profound sorrow for the horrific events in Orlando this past weekend and our support for the LGBT community nationwide. In the wake of a tragedy of this magnitude, one can only hope that our nation takes the collective opportunity to reflect upon our shared values and learn from the experiences of the moment.
The magnitude of the Orlando tragedy created the need for immediate information about family members and loved ones. We learned of President Obama's decision to issue an emergency waiver, at the request of Orlando's mayor, of the health information privacy protections embodied in the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
HIPAA, however, should not have been a bar to certain communications to loved ones and family. Although HIPAA was intended in part to help protect the privacy of individual health information, fear of legal repercussions has led many medical professionals and health care organizations to forget that HIPAA is carefully designed to balance out the desire for privacy with the practical need under certain circumstances for the free exchange of important information. That includes the need to keep a patient's loved ones informed about the patient's location, condition, and prognosis for recovery.
In Orlando, the mayor's request for a HIPAA waiver apparently arose from a local hospital executive's complaint that the law prevented his staff from providing any information to the families of victims. But nothing in HIPAA would have or should have prevented staff doctors, nurses, or registration staff from sharing the basic information that would let friends and family know a person close to them was hurt, but safe, and receiving care.
HIPAA allows medical professionals to disclose information relevant to a patient's health care or payment for care to immediate family members, other relatives, and any "close personal friend." When the patient is not able to give informed consent to the disclosure of personal health information, all that HIPAA requires from the medical professional is a reasonable professional judgment that sharing protected information will serve the patient's best interest. Unfortunately, misunderstandings about HIPAA often prevent doctors from sharing the type of information that would not only provide a measure of comfort, but would empower individuals likely to be involved with the patient's care to act as advocates on behalf of their loved ones.
President Obama's announcement of an emergency HIPAA waiver probably came as a relief to medical teams overwhelmed by the aftermath of the Orlando shooting. It probably came as a relief to victims whose first choice of emergency contact might not be an immediate relative by blood or marriage. It probably came as a relief to the LGBT community to find our nation's highest office offering a direct response to a very personal attack. But it probably wasn't necessary. HIPAA never stood in the way of providing information to the loved ones of Orlando's victims.
As stated in the CMS press release, the Northwest Wisconsin Concentrated Employment Program, Inc. (CEP, Inc.) and partners will serve uninsured children and their parents in 27 rural counties in western and northwestern Wisconsin. Many of these counties have large populations of children who are "eligible," but not enrolled in BadgerCare Plus.
CEP, Inc. will lead the project, titled "Wisconsin Coverage Connections," collaborating with navigators, advocates, and educators. CEP, Inc. will partner with other agencies that include four cooperative educational service agencies, two workforce partners, ABC for Health, Inc., ABC for Rural Health, Inc., and HealthWatch Wisconsin!In addition to direct service enrollment activities, including complex case resolution, outreach strategies include school-based outreach, developing culturally appropriate materials for Hispanics and other populations, access to bilingual services, conducting outreach events at libraries, schools, hospitals clinics, community centers, churches, and conferences. Partners plan to conduct large scale workshops at community events and the HealthWatch Wisconsin conference, training 200 clinician participants about Medicaid and CHIP eligibility. Stay tuned for more details as they unfold!
TOP STORY: State Releases May BadgerCare Plus Enrollment Data
The Wisconsin Department of Health Services released May enrollment numbers in BadgerCare Plus and Medicaid programs. The trends we have been following these past several months persist. Children continue to be dropped from BadgerCare Plus, as do childless adults.
The Medicaid Disability programs are actually seeing slight gains in enrollment. While MAPP, for example, continues to grow in participation, it is still an underutilized program!
TOP STORY: Nonprofit Hospitals Take a Second Look at Financial Assistance Policies
NPR Bursts the Bubble for Mosaic Life-Care's Aggressive Collection Practices
Following a 2014 NPR/ProPublica investigation into aggressive debt collection practices, a number of non-profit hospitals are taking steps to change their financial assistance policies. As reported in NPR/ProPublica's recent follow-up story, Mosaic Life-Care in Missouri attempted to reach patients with outstanding debts and allow them to apply for financial assistance under expanded eligibility guidelines. Deaconess Hospital in Indiana, which had filed more than 20,000 lawsuits against patients between 2010 and 2015, expanded its financial assistance policy and also allowed patients to file for financial assistance even after they had been sued by the hospital.The NPR/ProPublica investigation prompted further scrutiny from Sen. Chuck Grassley, R-IA, who in January 2015 launched his own investigation into the hospitals' compliance with Affordable Care Act reforms and IRS 501(r) regulations requiring hospitals to establish and publicize a financial assistance policy for patients.
TOP STORY: New Data on Poverty and Infant Mortality Rates
The New York Times recently reported that in 2014 over 23,000 infants died during their first year of life in the United States. This amounts to over 6 deaths per 1,000 live births, a rate that is higher than that of 25 other industrialized countries. Even when premature births are excluded from the analysis, the U.S. still lags behind other countries.
A number of factors appear to correlate with infant mortality, including race and ethnicity, mother’s age, and mother’s marital status. It is not clear, however, that additional prenatal care would decrease the infant mortality rate. According to the Centers for Disease Control, the majority of infant deaths occur during the neonatal period, or the first month after birth—4.04 deaths per 1,000 live births versus 1.93 deaths per 1,000 live births during the post neonatal period (between 1 and 12 months after birth). However, when researchers compared neonatal mortality to post-neonatal mortality, they found that U.S. neonatal mortality rates are similar to those of other countries.
TOP STORY: A Reminder on State Autism Mandates
In the June 12 Wisconsin State Journal, reporter David Wahlberg discussed autism treatment offerings in Wisconsin, and efforts to expand treatment offerings in the Madison area. While accurate, the article did not mention that over HALF of Wisconsin employer-sponsored health plans are actually governed by federal rules for self-funded ERISA plans. As advocates who assist with enrollment know, it is not uncommon to get a call from a family, frustrated that their insurance plan is not following Wisconsin law...only to determine that the health plan was not governed by Wisconsin law or the autism mandates it provides. Other federal protections could apply.
Autism coverage and treatment has been in the news lately, as the state Medicaid program is transitioning behavioral health treatment including autism treatment to a covered card service, instead of the old model of the waiver program, and relying on HealthCheck "other services" as the only route to coverage. We also remind families that Medicaid coverage in this regard can be backup for some families. The devil is in the details, of course, with these complicated coverage eligibility rules.
Medicaid Expansion Reduces States' Collection Debt
Early evidence suggests that states who adopted Medicaid expansion have seen a decrease in their medical debt (35% for 2014). On the flip side, states who have yet to expand Medicaid only saw an incremental decrease (less than 1% for 2014).
Researchers at the Federal Reserve Bank of New York State say: We offer suggestive early evidence that the Medicaid expansion is fulfilling the goal of health insurance: providing 'peace of mind' by protecting against financial hardship.
We are sure to see this debt decrease as more patients are offered services through Medicaid expansion. Speaking of the decrease in medical debt…
Political Commentator Erases $14.9 Million in Medical Debt
In one of the biggest on-screen giveaways in television history—at the press of a button—nearly $15 million dollars of medical debt belonging to approximately 9,000 people, vanished! On June 6, political commentator and TV show host John Oliver shed some much needed light on the mostly dark world of purchasable medical debt. With $60,000 and his new company: Central Asset Recovery Professional, Inc., (CARP), he purchased—not only their debt but also—names, current addresses, and social security numbers—an unsettling part of the topic for another time. For now, we identify a couple of important issues to remember about debt and consumer rights:
This brief moment of TV history surely changed the lives of those recipients, and also brought the issues of purchasable medical debt and repayment under the national spotlight. Since John Oliver can only purchase so much medical debt, hopefully more states adopt strategies to address appropriate assistance for patients and helping them connect to coverage programs on the front end of the hospital billing cycle. And an increase in states adopting a Medicaid expansion going forward wouldn't be a bad idea either.
TOP STORY: HHS Culture & Communication" Training Now Available
As a part of their series on Culture and Communication, the US Department of Health and Human Services (HHS) Office of Minority Health created a catalog of videos and training materials addressing Health Literacy, with a series dedicated specifically to Culture and Communication. This series is just one of several training sessions directed towards healthcare professionals of different backgrounds. The Physician's Practical Guide to Culturally Competent Care, is geared towards physicians, physician assistants, and nurse practitioners who are "interested in advancing health equity, improving quality, and helping to eliminate disparities." It is a self-directed training course to enable them to better treat the increasingly diverse U.S. population.
Bookmark It! Online Handbooks
When questions come up about either the Medicaid or BadgerCare Plus eligibility rules, the first place we go is to the online Handbook. As rules change it’s important to be sure you’re using updated information as you help consumers navigate coverage options. Last week, for example, the State Department of Health Services update the Medicaid Eligibility Handbook in release 16-01. As long as you have the Handbooks bookmarked, you’re in luck – you don’t have to upload a new link. The newest edition will use the same link – you might just have to refresh your browser to view changes.
Why else should you bookmark the handbooks? Because the rules vary based on a person’s situation and demographics, it can be difficult to remember all the rules. One key way to avoid making mistakes in benefits counseling is to reference the rules – the easiest way is to go to the Handbook. Remember, the Handbook is a guide, but is not a replacement for state statutes or federal Medicaid law. It is an accessible first reference tool.
For navigating all the information in each of these online handbooks, you’ll find a contents feature on the left side of the page and a search feature in the upper right corner.
Watch This! People First Language!
The words you use when speaking with patients matter! When talking about someone with a disability, do you indicate that they have the disability, or that they are the disability? You may be surprised how many people do the latter. In this Video Case Tip, we remind you of appropriate, respectful language!
To watch, Click Here or on the image at the right.
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.
Voices & Views: Medicaid Handbook Updates Avoid New CMS Inmate Guidelines
The Centers for Medicare and Medicaid Services (CMS) generated a good bit of attention last month when it issued new guidelines that would improve access to Medicaid services for incarcerated persons. Those new guidelines prompted a closer look at the sections about inmate policies when Wisconsin's Department of Health Services (DHS) issued a new update to its Medicaid Eligibility Handbook last week. Unfortunately, the new handbook language essentially just restates the longstanding Wisconsin rules about Medicaid for the incarcerated. However, a comparison between the updated Medicaid handbook and the current BadgerCare Plus Eligibility Handbook reveals one change that brings the two programs' rules closer into alignment, as well as a significant difference between Medicaid and BadgerCare policies that seems to offer favorable treatment to inmates without disabilities over those who may be elderly, blind, or disabled.
The most recognizable change to the Medicaid Handbook rules for inmates simply involved copying over language from the BadgerCare Handbook relating to applications for inmates who have multiple admissions for inpatient health care outside of a correctional facility. As a general rule, correctional institutions are legally required to provide health care for inmates and health care services provided inside the correctional facility are not eligible for federal Medicaid reimbursement. On the other hand, if an inmate requires medical services that cannot be provided in the correctional environment, those services can be reimbursed by Medicaid as long as the inmate is otherwise eligible for Medicaid and is admitted for an inpatient stay of at least 24 hours. The most recent update to the BadgerCare Eligibility Handbook included a new section explaining that inmates who experience more than one qualifying inpatient admission must reapply for BadgerCare with every new admission. The updated Medicaid handbook now includes the same language.Unfortunately, Wisconsin's current policy seems to require exactly the opposite of what CMS intended with its May guideline release.
3 C's for CYSHCN! "Competency, Capacity, & Coordination"
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Featured Resource: A Gift To Your Family
End of life decisions are some of the most important, yet challenging decisions a family will face. The State Bar of Wisconsin has produced a resource to help facilitate this decision making process. In the practical guide titled, "A Gift to Your Family," the authors offer practical insights on end-of-life decisions, and include state forms to help people put their wishes in writing. Share the guide with clients, family, and friends to help them start this important conversation.
Featured Videos: Telecommunications Assistance Programs
Wisconsin's Public Service Commission administers programs to make telecommunications both affordable and accessible in Wisconsin. For low-income consumers looking for assistance with monthly phone bills - or - a free cell phone, the Lifeline program may be an option. For an individual with a disability - deafness, hard of hearing, mobility impairment, for example, the Telecommunications Equipment Purchase Program (TEPP) may help get accessible equipment in the home. For more information on these and related programs, watch our new "Introduction" videos below!
|Introduction to Lifeline & Linkup|
|Introduction to TEPP & TAP|
Interested in more information on Lifeline and Linkup programs in Wisconsin? Visit our Video Case Tip Library for all our Telecommunications Assistance program videos.
Local HWW coalitions remained active last week! The Dane and Milwaukee County HealthWatch Coalitions met 6/6, and 6/8, with about fifty total people attending these meetings.
Dane County HealthWatch Coalition Update: The featured presenter at the June 6 meeting was the "Journey to Health and Wellness Team" from Journey Mental Health Center. The team includes two wellness coaches, a nurse, a medical assistant, and an AODA counselor, and the team will provide ten weeks of support to program participants- while focusing on ten resiliency factors. The Health and Wellness team looks forward to working with program participants and will target diabetes, cardiovascular disease, and lung disease. Usual meeting updates were also provided by DHS, the Dane County ADRC, and the Capital Consortium.
The next Dane County HealthWatch event is the Pontoon Porch, taking place on Wednesday July 20! For more info, please contact email@example.com, or call (608)261-6939 extension 218.
Milwaukee County HealthWatch Coalition Update: Frank Robinson, Supervisor of the City of Milwaukee's Community Healthcare Access Program (CHAP), presented at the June 8 meeting, providing an overview of the Milwaukee Health Department’s programs and services, including helpful information and tips about the Wisconsin Well Woman Program, WIC, CHAP, and more. Specifically, Milwaukee’s CHAP program focuses on enrollment, troubleshooting cases/reviews, and expediting the sometimes bureaucratic process of connecting individuals to programs and benefits. Robinson also emphasized the importance of post-enrollment support; being able to explain ‘what to do’ after being approved for a program or benefit. When a resident reaches out to Milwaukee's CHAP, they are asked "How can we help you?" and an effort is made to connect the resident to the best solution. It’s worth mentioning that President Obama visited Milwaukee about two months ago to congratulate the community for winning The Healthy Communities Challenge, a contest hosted by the White House with the goal of increasing enrollment in major metro areas. Masiel Gomez and Sarah Fraley from DHS also shared updates from state programs and benefits, and answered questions.
The next Milwaukee HealthWatch meeting will take place August 10 at Aurora Family Services. For more info, please call (608)261-6939 ext. 218 or email firstname.lastname@example.org
Polk County HealthWatch Coalition and the regional Polk Co. Safetyweb Network will host a training on June 24th at the Health Department in the Polk County Government Center in Balsam Lake titled, “Who’s Whose?” The event will begin at 10:00 AM and end at noon. This is a training for professionals and other assisters who help families with health care coverage. Brief sessions on Medicaid and the Marketplace for incarcerated persons, Mental Health Parity, and new rules for Medicaid HMO’s will also be reviewed. For more info, contact Mike Rust with ABC for Rural Health: MikeR@co.polk.wi.us.
Interested in Joining a Coalition in Your Area?CLICK HERE to learn more about meetings of a HealthWatch Coalition in your region of the state.
Next Meeting of the HealthWatch Wisconsin Leadership Council
The date is set! The next meeting of the HealthWatch Wisconsin Leadership Council is Tuesday, June 28 at 1pm! At this meeting, we will introduce new Council members and discuss the start of the new HealthWatch Wisconsin membership year, which begins July 1. This meeting will be conducted largely by phone. HealthWatch WI members interested in attending can call for more information: (608) 261-6939 ext. 218. Thank you to all our Council members for your leadership!
For more information email your local HealthWatch Coalition contact below, or email us
|Chippewa County||Sept. 13||Rose Marsh|
|Dane County||July 20 (picnic)||Anna Kaminski|
|Eau Claire||Sept. 1||Lou Kelsey|
|Milwaukee||Aug. 20||LaCresia Mason|
|Pierce County||TBD||Rebecca Tomasek|
|Polk County||June 24||Mike Rust|
|Tri-County||June 28||Connie Raether|
HHS: ACA bumped health coverage in rural counties up 8%, HealthcareDive
Wisconsin's 1115 Medicaid Demonstration: What Will Policymakers Learn?, The Commonwealth Fund
Additional Links of Interest
Nearly All ACA Benchmark Plans Violate Rules on Addiction Treatment Coverage, Modern Healthcare
Measuring Progress on Mental Health and Substance Use Disorder Parity, U.S. Department of Health and Human Services
Parity "Warning Signs" And an Employer Shared Responsibility Estimator, Health Affairs Blog
Autism treatment offerings expand in Madison, Wisconsin State Journal
Commissioner Nickel Appoints J.P. Wieske as Deputy Commissioner, Wisconsin Office of the Commissioner of Insurance
Sitting is the New Smoking, Wisconsin Public Radio
Et Cetera: Memos & Updates
HandbooksFoodShare Handbook, Release 16-01 published May 31, 2016.
Marketplace Handbook: On October 1, 2015 CMS's Center for Consumer Information and Insurance Oversight released an updated FFM and FFM-SHOP Enrollment Manual. Effective October 1.
BadgerCare Plus Handbook, published February 15, 2016 in Release 16-01
Administrator's Memo 14-04, 2015 IM Consortia Administrative Allocation, has been published to the DHS web
Release 15-01 of the Electronic Case File (ECF) Handbook was published on January 16th
Release 15-01 of the FoodShare Handbook was published
16-16: New Policy Regarding a QUEST Card Replacement Fee, June 1, 2016
16-15: Spousal Impoverishment Income Allowance Federal Poverty Level Adjustment, May 26, 2016
16-14: Work Requirement for Basic Education and Technical Education or Course of Study Leading to Employment, May 3, 2016
16-13: Wisconsin Shares Self-Employment Policy, May 2, 2016
16-12: CWW Enhancements for Child Care Interviews, April 27, 2016
16-11: Child Care and School Program Collaboration, April 25, 2016
16-08 (AMENDED): WI Shares Child Care Eligibility Verification
16-07: Enforcing the 40% Rule for Children of Child Care Provider Employees, May 16, 2016
16-06: Policy Clarifications for Able-Bodied Adults Without Dependents Exemption for Members Who Are Unfit for Employment, April 11, 2016
Other ForwardHealth Announcements:
The ForwardHealth Provider Portal HealthCheck User Guide was recently revised and was posted to the ForwardHealth Portal on June 3, 2016. Revisions to the user guide include:
Conversion to new formatRemoval of outdated schedule information ForwardHealth user guides and instruction sheets provide users with step-by-step instructions on navigating specific Portal functionality; they do not contain policy information. For complete ForwardHealth policies and procedures, please refer to the Online Handbook on the Portal.
Funeral & Cemetery Aids Program Memos:
Required Forms for WFCAP Payments, June 13, 2016
2016-19: Prior Authorization Required for Rosuvastatin Tablets
2016-20: Prior Authorization Will No Longer Be Required for OnabotulinumtoxinA (Botox®) When Used to Treat Chronic Migraines
2016-21: Prior Authorization Will No Longer Be Required for Crinone® When Used for Certain Indications
Tell Us What You Think!
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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.
Special thanks to ABC for Health staff for their contributions to this Update Newsletter