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Vol. 12, No. 13 July 14, 2016

Welcome to the HealthWatch Wisconsin Update Newsletter, a bi-monthly publication with exclusive features for members of HealthWatch Wisconsin.

In this issue...

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A learning and policy collaborative that promotes improved access to health care coverage and services. HealthWatch provides on-demand communication and training materials and methods to assure a more sufficient, competent, and coordinated public health workforce in Wisconsin. Click on the button below to join or renew your membership!

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TOP STORY: Voices & Views: OCI Complains About the Consequences of Its Own Inaction

On Monday, Wisconsin's Insurance Commissioner, Ted Nickels, released an op-ed piece railing against proposed rules issued by the federal Department of Health and Human (HHS) Services for automatically re-enrolling Marketplace insurance customers whose current health plan will not be offered through the Marketplace in 2017. Nickels portrays the rules as something of a snare trap for the unwary consumer who is offered "no way to opt out" of automatic enrollment into a different Marketplace plan. He portends "chaos" for consumers automatically enrolled into plans offering different provider networks and describes the proposed rules as "costly federal intrusions."


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TOP STORY: BadgerCare Plus Enrollment Numbers for June

The Wisconsin Department of Health Services has released BadgerCare Plus enrollment numbers for the month of June. The trend continues: Wisconsin continues to lose children from BadgerCare Plus. A decline in enrollment could mean signs of an improved economy - more folks back to work, at jobs that include insurance for the family.

However, this week the Wisconsin Council on Children and Families (WCCF) issued a report suggests the issue is broader. WCCF's Jon Peacock says Wisconsin's status of having one of the lowest rates of uninsured children is slipping because the state dropped parents from Medicaid and hasn't made it easy to enroll in state coverage. The report says that 4.4% of Wisconsin's children were uninsured in 2014 - that's 58,000 children.

Why is Wisconsin slipping? Peacock points to a recent Urban Institute study regarding participation of eligible children in Medicaid and Children's Health Insurance Program (CHIP), combined to be called BadgerCare Plus in Wisconsin. In their study, the Urban Institute says Wisconsin dropped below the national average of eligible children participating in coverage.

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TOP STORY: Public Option Resurrected by Democratic Leaders

Back in 2009, the public option died.

Video Case Tip: What is a Public Option?

Public Option, once wovened into the fabric of the Affordable Care Act until being stripped away by conservative Democrats on the floor of the Senate, was buried.  But now President Obama, presumptive Democratic presidential nominee Hillary Clinton, and the 2016 Democratic National Convention Committees' official platform have called for the resurrection of the public option.

Democrats argue that by creating a public option, more people would have access to quality coverage and put pressure on private insurance companies to refine their practices of offering poor coverage at inflated prices. Republicans argue that this may would lead to a rise in government-controlled insurance and squeeze out private insurers.

For more information on what the public option is, CLICK HERE or on the image at right.

Health Insurance Consumer Protection Rule Quashed by Court

A federal appeals court recently struck down a consumer protection regulation issued by the Department of Health and Human Services (HHS) under the Affordable Care Act. The HHS regulation aimed to protect consumers against unwittingly buying certain types of health insurance plans that do not meet ACA standards for minimum essential coverage.

The regulation restricted the sale of certain types of "fixed indemnity" insurance plans. Generally speaking, fixed indemnity plans are intended to supplement comprehensive health insurance coverage by providing a means to cover out-of-pocket costs or non-medical expenses. These types of fixed indemnity plans typically pay a fixed dollar amount over a certain period of time whenever a qualifying event happens, such as $350 per day of hospital confinement. However, other types of fixed indemnity plans pay a maximum flat rate per medical service received, such as up to $500 per hospital admission or up to $50 per doctor visit. The HHS regulation allowed the sale of these "per-service" type of fixed indemnity plans, but only under certain conditions.

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CMS Clarity for Family Planning on Medicaid

"Medicaid accounts for three-quarters of public funding for family planning in the United States. CMS' sweeping new regulations and three additional pieces of guidance to state officials together form the most comprehensive set of rules, principles, and recommendations for states that CMS has offered on the subject," says Adam Sonfield of Health Affairs Blog.

The new guidance for Medicaid coverage of family planning services ensures access to free choice of family planning methods and providers for Medicaid-covered women.

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Voices & Views: Bill Aims to Make Medicaid Enrollment Smoother for Those Leaving Jail in Pennsylvania

Recent editions of the HealthWatch Wisconsin Update have featured articles about new federal policy guidance encouraging states to adopt procedures that would help eligible inmates transition smoothly to Medicaid health coverage on release from incarceration. Although Wisconsin has given no indication that it is working to implement the new federal guidance, legislators in the state of Pennsylvania have already presented a bill to governor Tom Wolf proposing changes to the state's Human Services code that would do just that.

Under current law, Pennsylvanians returning to the community after serving a jail or prison are required to submit a new Medicaid application which takes a minimum of 45 days to process. That leaves former inmates facing at least a month and a half with no health care coverage and no access to needed medications. The new bill, sponsored by Republican state senator Pat Vance, would allow the state Department of Human Services to place inmates in a "suspended" enrollment state under which Medicaid services could resume on the first day of the individual's release from incarceration.

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Bookmark It! Evidence-Based Toolkits for Rural Community Health

In this Update's "Bookmark It!" section, we share seven toolkits in one link! The Rural Health Information Hub, formerly known as the Rural Assistance Center, has produced what it calls "step by step guides" to help individuals working in community health with their "Evidence-Based Toolkits for Rural Community Health."

With steps and best practices collected from evidence-based community programs, the toolkits are designed to give advice that is easily adapted to fit each unique community - with a special focus on rural areas. Covering topics ranging from mental health and substance abuse services to dental health and obesity prevention, these toolkits help professionals learn about shared obstacles, connect with experts, or share advice on how to evaluate your own programs to show impact.

Watch This! Dealing with Medical Bills and Debt

There is no shortage of advice of how to "deal with a medical bill." From "top ten" lists in the local paper and "how-to" guides on getting a Kickstarter campaign set up, to new legislation in some states on surprise medical bills. Folks are still struggling to figure out tangible steps to take once a medical bill arrives in the mail. In this Video Case Tip, we sift through the information and provide guidance on dealing with medical bills, with content pulled directly out of ABC for Health and HealthWatch Wisconsin's "My Medical Debt Survival Guide."

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.

3 C's for CYSHCN! "Competency, Capacity, & Coordination"

Ask a Good Question...

My son is covered by Katie Beckett Medicaid and on an IEP at school. He receives speech therapy through the school, but his pediatrician says he also needs private speech therapy. What can my son's providers do to ensure that Medicaid will pay for the private speech therapy?

Get a Good Answer...

Login to the training portal to read the answer to this week's question!

Safetyweb Network: What are Mental Health HPSAs?

In Wisconsin, there are two kinds of Qualified Treatment Trainees (QTT) the first are graduate students enrolled in accredited institutions in psychology, counseling, marriage and family therapy, social work, nursing, or a closely related field. Services provided by these QTTs as part of a practicum were reimbursable by Wisconsin Medicaid prior to 2012.

The second are individuals who have a graduate degree from an accredited institution and course work in psychology, counseling, marriage and family therapy, social work, nursing, or a closely related field who have not yet completed the applicable supervised practice requirements (often referred to as 3,000 hours) for licensure as a clinical social worker, certification as a social worker, licensure as a professional counselor, licensure or certification as a marriage and family therapist, or licensure as a psychologist.

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Covering Wisconsin Enrollment Conference: Save the Date

Covering Wisconsin has announced the Wisconsin Enrollment Conference will take place September 19-20, 2016 at the Kalahari Resort in Wisconsin Dells, Wisconsin.

This two day conference is an opportunity for you to connect and share resources with health insurance enrollment professionals from around the state.

For more information, visit www.coveringwi.org

HealthWatch Wisconsin Corner

County HealthWatch Coalition Updates:

The next Dane County HealthWatch Coalition event is the Pontoon Porch, taking place on Wednesday July 20! For more info, please contact Anna, or call (608)261-6939 ext. 216.

The next Tri-County HealthWatch Coalition meeting will be a special July 26 luncheon! Contact Connie for details!

The next Milwaukee HealthWatch Coalition meeting will take place August 10 at Aurora Family Services. For more info, please call (608)261-6939 ext. 218 or email Matt!

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.

Coalition Corner

For more information email your local HealthWatch Coalition contact below, or email us

Coalition Next Meeting Contact
Chippewa County Sept. 13 Rose Marsh
Dane County July 20 (picnic) Anna Kaminski
Eau Claire Sept. 1 Lou Kelsey
Milwaukee Aug. 10 Joanna Woodbury
Pierce County TBD Rebecca Tomasek
Polk County TBD Mike Rust
Tri-County July 26 Connie Raether

Featured Headlines

Family Care and IRIS Programs Expand to Rock County, Department of Health & Human Services

The Effects of Medicaid Expansion Under the ACA: Findings from a Literature Review, Kaiser Family Foundation

Impact of ACA on Medicaid Expansion On Insurance Coverage and Access to Care, Department of Health & Human Services

Helping SEPs Work Under the Affordable Care Act, Urban Institute

Medicaid Expansion: Driving Innovation In Behavioral Health Integration, Health Affairs Blog

Integrating Medical and Social Services; A pressing priority for health systems and payers, Health Affairs Blog

Wisconsin Senators Ask FCC to Expand Rural Broadband Access, The Cap Times

Additional Links of Interest

Wisconsin Continues Partnership with Veterans Assistance Foundation, Ranked One of Worst in Nation, The Cap Times

Wisconsin Lagging in Improving Rate of Insured Children, Channel 3000

Wisconsin Ranking for Uninsured Children Slipping, Wisconsin State Journal

United States Health Care Reform; Progress to Date and Next Steps, The Journal of the American Medical Association

Many Toddlers Fail to Get Necessary Medicaid Renewal at Their First Birthday, Kaiser Health News

Obama Renews Call for a Public Option in Health Law, Kaiser Health News

Survival of the Sickest: Health Insurer Assurant Settles Discriminatory Pricing Complaint, International Business Times

Providers, Insurers Play Blame Game Over Patients' Surprise Medical Bills, Kaiser Health News

Medicaid Private Insurers Begin to Lift Curbs on Pricey Hepatitis C Drugs, Kaiser Health News

Young Adults Can Face Challenges to Health Enrollment, Kaiser Health News

Et Cetera: Memos & Updates


NEW! Medicaid Eligibility Handbook (MEH), published Jun. 24, 2016 in Release 16-02

NEW! ACCESS Handbook, published July 11, 2016 in Release 16-01


FoodShare 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

Ops Memos:

16-19: Child Care EBT PP Conversion Process

16-J3: Archiving CARES Worker Web and CARES Data

16-18: Updated Institutional Cost of Care Values
16-17:Reasonable Compatibility for the Medicaid Purchase Plan
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:

Changes have been made to the Pharmacy Resources page on the ForwardHealth Portal.

The ForwardHealth Provider Portal Dental Claims User Guide was recently revised and was posted to the ForwardHealth Portal on July 8, 2016. Revisions to the user guide include:

  1. Documentation of new OI Circumstance field
  2. Layout converted to new format

The ForwardHealth Portal Demographic Maintenance Tool User Guide was recently revised and was posted to the ForwardHealth Portal on July 8, 2016. Revisions to the user guide include adding documentation for the new Private Duty Nursing for Ventilator Dependent Members Life-Support Addendum Panel.

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

Administrator's Memo:

16-04 "QUEST/Vault Card Process & Procedures"

16-05 "Enhanced Federal Funding for Qualifying IM Activities"

Provider Memos:

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

2016-22: July 2016 Preferred Drug List Review and Other Pharmacy Policy Changes

2016-23: Reporting Other Health Insurance Information on Dental Claims

2016-24: New Coverage and Prior Authorization Policy for Gait Trainers

2016-25: Information for Eligible Professionals Regarding Program Year 2016 of the Wisconsin Medicaid Electronic Health Record Incentive Program

2016-26: Implementation of the All Patient Refined Diagnosis Related groups Classification System

2016-27: Managed Care Program Length-of-Stay Policy Change for Institutions for Mental Disease

2016-28: Prior Authorization No Longer Required for Cochlear Implant and Bone-Anchored Hearing Device Implant Surgeries

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.
Update Staff:

Special thanks to ABC for Health staff for their contributions to this Update Newsletter