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Vol. 12, No. 09 May 17, 2016

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

In this issue...

We are thrilled to announce a new, major National Institute of Health technology grant has been awarded that includes ABC for Health and HealthWatch Wisconsin! The new funding promotes education strategies that reduce health disparities through workforce training that addresses the rapidly changing health care coverage program rules, requirements, and eligibility.

The proposed Learning Management System (LMS) software called GURULZ(TM), will provide an initial assessment of trainees and establish a web based on-demand curriculum to train and maintain workforce competency about health coverage program rules and requirements. Read our breaking news story below!

We also remind our members that a new membership year is just around the corner! July 1 starts a new membership year. Watch your inbox for more details on renewals and promotions!

Also, the last few weeks have been busy for CMS. They have finalized sweeping rules on Medicaid Managed Care and Health Equity- we take a look at those below. We also review the departure of Humana from the Wisconsin individual market, and take a closer look at Sen. Tammy Baldwin's newly proposed SAME Legislation, and what it could mean for states like Wisconsin which have not yet expanded Medicaid...but could!

Lastly, we've linked up some interesting articles, ops memos, and provider memos. Happy reading!

Enjoy this "free" version of the newsletter! Are you a member of HealthWatch Wisconsin? Click on the red button below to start reading the full version of this newsletter! Remember to enter your login and password when prompted.

Did you attend the HealthWatch Wisconsin conference? You can use your conference web page login credentials to also read this Update newsletter in the Training Portal!

If you are new to the Training Portal, simply click "register" after clicking on the red button above. Answer the questions, create a username and password, and we'll help you take it from there!

Not a member? Click here to join HealthWatch Wisconsin! If you would like to register over the phone or have questions about the registration process, please call 608-261-6939 ext. 218.

Top Story: Major New NIH Technology Grant Award Includes HealthWatch Wisconsin and ABC for Health, Inc.

Madison-Based Health IT Company is Awarded Major Research Grant to Reduce Health Disparities

Madison, WI – My Coverage Plan, Inc., a for-profit subsidiary of Madison-based non-profit ABC for Health, Inc., secured a major Small Business Innovation Research (SBIR) grant of up to $1.6 million over 5 years from the National Institutes of Health, Institute on Minority Health and Health Disparities. My Coverage Plan, Inc., is an early stage company developing disruptive technology solutions to reduce health disparities. Its local provider partner is St. Mary’s Hospital in Madison. "Our health care revenue cycle technology and solutions provide a win for patients and providers and promotes Madison as a leading developer of Precision Patient Advocacy(TM) technology," says Bobby Peterson, founder and President of My Coverage Plan, Inc.

My Coverage Plan, Inc., founded in 2010 with a separate SBIR grant, secured a patent in 2012 on a software application that that acts like TurboTax® but for health coverage. The tool screens, identifies, and optimizes current and future public and private healthcare coverage and generates an electronic health coverage record. Improper alignment of health care coverage exacerbates medical debt issues and intensifies existing health disparities and increases costs.

The new funding promotes education strategies that reduce health disparities through workforce training that addresses the rapidly changing health care coverage program rules, requirements, and eligibility. The proposed Learning Management System (LMS) software called GURULZ(TM), will provide an initial assessment of trainees and establish a web based on-demand curriculum to train and maintain workforce competency about health coverage program rules and requirements. The GURULZ(TM) LMS system evolved from corporate parent ABC for Health, Inc. (ABC), HealthWatch Wisconsin, and training programs for Patient Advocates, Health Benefits Counselors, and Attorneys who help low income people identify and optimize health coverage.

"Some folks called ABC staff the 'gurus of health coverage rules,' so GURULZ(TM) is our creative mash-up of that specific expertise," said Peterson. "Pro-active patient engagement with trained and competent staff promotes better health outcomes, improves customer service, and enhances community health all while reducing uncompensated care. In 2014, uncompensated care totaled over $1.3 billion in Wisconsin. We can do much better," said Peterson.

Phase 1 of the SBIR funding includes a comprehensive evaluation to establish proof of concept of GURULZ(TM) from 2016-2018. A subsequent three-year funding period is available to promote commercialization of the technology. GURULZ(TM) will help health care providers and patients secure optimized coverage across Wisconsin and potentially across the nation. Peterson adds, "As a leader in Precision Patient Advocacy(TM) we hope to stay in Madison, Wisconsin, but will carefully evaluate the best environment that promotes economic stability and growth for our high-tech company. With our patented technology and a boost in research funding, My Coverage Plan, Inc. will enhance a local culture of innovation, high tech job creation, and growth."

Peterson adds, "Our strategic partnership with ABC for Health, Inc., St. Mary's Hospital, and SSM Health Care can promote new efforts to train staff, engage patients and chip away at uncompensated care locally and eventually across the country. GURULZ(TM) will provide cutting edge training that informs learners of myriad nuances of both public and private health coverage options to help patients and dramatically reduce uncompensated care."

Peterson concluded, "The timing is right for this technology. The emergence of Insurance Marketplace, coupled with many other program options aligns perfectly with our new patented technology solutions to support training, reduce health disparities, and promote and optimize consumer choices."                     
National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number 1R43MD011209 - 01A1 supports the research of this initiative.  More information is available at www.mycoverageplan.com.

TOP STORY: New Membership Year Begins July 1!

The start of a new HealthWatch membership year is almost here! The HealthWatch Wisconsin membership years run July 1 - June 30. A HealthWatch membership provides valuable benefits such as a voice in statewide advocacy that works toward quality and accessible health care for people across Wisconsin, electronic publications, on-demand training videos, and other resources through the HealthWatch Training Portal, and substantial discounts on registration for trainings, workshops, and conferences on health care hot topics in 2016 and beyond!

Current HealthWatch Wisconsin members: Watch your inbox for an opportunity to renew your membership while taking advantage of new membership benefits!

In order to keep enjoying the wonderful benefits provided through HealthWatch, members will need to renew their current memberships for the 2016-2017 HealthWatch year. We also encourage you to identify non-members who may benefit from joining us in our efforts!

Considering joining HealthWatch for the first time? Registration for the new membership will open soon! Watch your inbox, or give us a call at any time: 608-261-6939 ext 218.

CMS Issues Sweeping Guidance on Health Equity

Last week, the US Department of Health and Human Services (HHS) Office of Civil Rights finalized a rule that implements important anti-discrimination provisions of the Affordable Care Act.

Inside "Section 1557," the language of health reform's hefty law passed in 2010 prohibits discrimination based on race, color, national origin, age, or disability by any health program or "activity that receives federal funding or is administered by a federal agency or entity established under Title I of the ACA." In effect, this means the language attaches to Medicaid programs, advance premium tax credits, navigator programs, and all programs that get federal money through HHS. It's broad in scope, yet does not go as far as many advocates would like, which according to Health Affairs Blog post by Timothy Jost would be to attach to any and all health programs regardless of HHS funding. The guidance does suggest that other agencies adopt similar language.

The guidance comes at a time when the nation is having a very public conversation on discrimination. The policy rules here are being championed by members of the transgender community, advocates for individuals with disabilities, and immigrant rights supporters including those seeking support for individuals with Limited English Proficiency. As for the former, the rule specifically notes that individuals may not be excluded from a facility for which they are otherwise eligible based on their gender identity. It explicitly prohibits discrimination by insurers against transgender individuals in the provision of services, including gender transition services.

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TOP STORY:  Sen. Baldwin Introduces "SAME" Legislation

In HealthWatch Wisconsin's February 1 Update Newsletter, we described the Obama Administration's intent to create an incentive for states to expand Medicaid.  Under the Affordable Care Act, the federal government has vowed to pick up the entire cost of state Medicaid expansion through 2017. By 2020, and thereafter, the federal government will cover 90% of state's costs.

Many state legislatures that have not expanded Medicaid see 2020 as a closely approaching number, and therefore continue to think of expansion as implausible for their state, often citing budget concerns. The Obama administration has paid attention to this. As President Obama continuously advocates for expansion, he announced a new plan in the 2017 federal budget to include three years of full Medicaid matching funds to any state that expands Medicaid, even if it is after the 2020 mark.

At the end of April, Wisconsin Senator Tammy Baldwin introduced legislation to encourage states to do just that- expand Medicaid to individuals living at or below 138% of the federal poverty level (FPL), while accessing the same level of federal matching funding as states that expanded earlier under the original terms of the Affordable Care Act. The States Achieve Medicaid Expansion (SAME) Act of 2016 was introduced by Sen. Baldwin along with Senators: Mark R. Warner (D-VA), Debbie Stabenow (D-MI), Claire McCaskill (D-MO), Jon Tester (D-MT), Angus King (I-ME), Tim Kaine (D-VA) and Gary Peters (D-MI).

As a non-expansion state, Wisconsin is unique. In 2014 the state removed the cap on enrollment for able-bodied childless adults, and all childless adults living at or below 100% FPL became eligible for Medicaid. However, parents and caretakers went from being covered at 200% of the FPL (the state required parents living over 133% FPL to pay an insurance premium to maintain coverage) to 100% FPL. In addition, Wisconsin tax payers cover the cost of the expansion to childless adults (which saw an unprecedented spike in enrollment); unlike opting to expand Medicaid under the federal government, which brings tax payer dollars back to Wisconsin. An analysis by the Wisconsin Budget Project found that in 2015, each additional 1,000 childless adults enrolled in BadgerCare created a $3 million cost in the biennium budget. The Legislative Fiscal Bureau also did some research, and found that by expanding Medicaid to 138% FPL under the federal government, the state could save over $300 million in 2017.  Yet, Wisconsin still follows a puzzling and more expensive path. 

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TOP STORY: CMS Makes Sweeping Changes to MA Managed Care

In the last week of April, the Centers for Medicare and Medicaid Services (CMS) issued a 1,425 page final rule to "guide the delivery of health care" for the millions of Americans enrolled in Medicaid Managed Care plan. The rule was described in the CMS Press Release as being one that would "modernize Medicaid." The "overhaul" is the first of its kind in a decade, designed to "transform the health care system to deliver better care, smarter spending, and healthier people," according to CMS. On a practical level, the rule supports state delivery system reforms with quality rating systems and a clarification of state authority to enter into things like alternative payment models or other delivery system reforms. It improves key consumer protections by improving transparency and accountability. It creates a central contact for complaints, enrollment assistance, and appeals. It includes network adequacy standards in Medicaid for key provider types. It builds efficiencies by aligning rules of health coverage programs, especially important to those transitioning or coordinating multiple coverage systems.  

In a matter of two weeks, CMS implemented two sweeping rules grounded in health equity, and with good reason. The populations most impacted by Medicaid Managed Care rules are those low income, health disparity populations. The policies of administering Managed Care very quickly get into complex conversations about delivering - and paying for - health care for the lowest income and potentially highest risk populations.

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TOP STORY: Humana Pulls Out of Individual Market

In our last Update Newsletter, we reviewed UnitedHealth Care's decision to once again sit out of the next Health Reform Marketplace Open Enrollment in select states, but not in Wisconsin. This week, Humana announced it would discontinue its individual plans in Wisconsin in 2017 - but these were not plans sold in the Marketplace, but instead were sold outside the Insurance Marketplace established under the Affordable Care Act.

Individuals with Humana plans will continue to have coverage through the balance of their current plan year, expiring on December 31, 2016.  Overall, according to an article in the BizTimes, Milwaukee Business News, the impact is relatively small, only 6,639 people, compared to the over 240,000 with individual plans after the last Open Enrollment Period.

But, none the less, the reason Human gave for its exit leaves some scratching their heads. Humana simply stated that they had "issues," that couldn't be overcome over the last few years, according to a letter sent to Wisconsin's Commissioner of Insurance. The "issues," were not described in detail. Humana has been decreasing its individual plans for years, instead turning its attention to Medicare Advantage Plans, its core business, which has experienced strong growth. Recent struggles with company profits have been attributed by the Wall Street Journal to both a drop in commercial market enrollments and costs associated with its pending merger with Aetna.

TOP STORY: DHS Releases April BadgerCare Plus Enrollment Data 

BadgerCare Plus lost over 4,000 enrollees in the month of April, over half of which were Childless Adults; the other half was almost all children. Could this be the sign of a recovering economy or the impact of other policy changes? Medicaid program enrollments were up in both the "Elderly Blind Disabled (EBD)" Medicaid and Medicaid Assistance Purchase Plan (MAPP) programs.

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Bookmark It! "Extra Help"

This week's Bookmark It! Section, we look at the Social Security program called "Extra Help."

What is Extra Help?

From the Social Security Website: Anyone who has Medicare can get Medicare prescription drug coverage. Some people with limited resources and income may also be able to get "Extra Help" to pay for the costs—monthly premiums, annual deductibles and prescription co-payments—related to a Medicare prescription drug plan. The "Extra Help" is estimated to be worth about $4,000 per year. Many people qualify for these important savings and don’t even know it.

Bookmark these two links to help identify who is eligible for "Extra Help," and have a ready resource that identifies the income and asset limits for this program:

Social Security Publication on Extra Help

Income & Asset Limit Chart from the Medicare Rights Center

To qualify for Extra Help, generally, the eligibility is as follows:

  • You must reside in one of the 50 states or Washington DC;

  • Your assets must be limited to $13,640 for an individual or $27,250 for a married couple living together. (Resources include such things as bank accounts, stocks and bonds.) Not counted: home, car, or any life insurance policy; and

  • Your annual income must be limited to $17,820 for an individual or $24,030 for a married couple living together. Even if your annual income is higher, you still may be able to get some help.

Watch This!  Gifts!

It's graduation season! What does it mean for someone's BadgerCare Plus eligibility if they were to receive a gift, say, a graduation gift of money from a relative? Is it counted as income? Unearned income? What if it is gifted indirectly (say Grandma wrote a check to defray some of that tuition cost)?

The BadgerCare Plus definition of a gift is something a person receives that is NOT repayment for goods or services the person provided, and is not given because of a legal obligation. It also can't be taken back - it is an irrevocable transfer!

We look at how to treat gifts, including cash gifts, in this week's Featured Video Case Tip! 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 daughter, age 25, was just told that she is not eligible for tax credits in the Marketplace because she has access to insurance that would qualify as "minimum essential coverage." Yet, she isn't insured! What could be going on?

Get a Good Answer...

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

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.

Rural Corner: Topics of Interest to Rural Wisconsin

At the end of April, the Centers for Medicare and Medicaid Services (CMS) issued a "Fact Sheet' titled "Serving Special Populations: Rural Areas Fast Facts for Assisters." Designed for those helping others enroll in Marketplace coverage, such as Navigators, CACs, and others assisting in enrollment and eligibility evaluations.

The brief, five-page guide is designed to help minimize some of the unique obstacles professionals face when working in predominantly rural areas. Consumers may be hard to reach, face limited choice and access to care, concerns about affordability, barriers to communication, lack of transportation, and more.

States that did not expand Medicaid are disproportionately rural, which, according to the fact sheet, means rural consumers may be facing limited health insurance options overall. It provides strategies to overcome many of the outreach and educational barriers, but overall cannot compensate for things like a lack of network adequacy or professional shortage areas.

Rural Corner is a regular feature of 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. Questions on the Safetyweb Network? Send an email to ABC for Rural Health!

HealthWatch Wisconsin Corner

New Content in the Training Portal!

Attention all HealthWatch WI Conference attendees: Video footage from the 9th Annual Conference has been updated to the Conference webpage inside the HealthWatch Wisconsin Training Portal! Re-watch some of your favorite plenary sessions or a TED-style Talks from the event.

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!

Coalition Corner

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

Coalition Next Meeting Contact
Chippewa County September 13 Rose Marsh
Dane County June 6 Anna Kaminski
Eau Claire June 2 Lou Kelsey
Milwaukee June 8 LaCresia Mason
Pierce County May 23 Rebecca Tomasek
Polk County TBD Mike Rust
Tri-County May 24 Connie Raether


Meeting the Mental Health Needs of Wisconsin's Children, WCCF

Supreme Court punts cases over ACA's contraception mandate, wants compromise, Modern HealthCare

Insurers Must Provide Services Regardless of Gender Identity, Washington Post

Study finds much higher prices for medical services in Wisconsin, Journal Sentinel

Louisiana gets innovative to catch up on Medicaid Expansion, NOLA.com

Sounds Like A Good Idea? Selling Insurance Across State Lines, Kaiser Health News

Questions Emerge About the Impact of State Autism Insurance Mandates, Kaiser Health News

Patients With Skimpy Health Insurance Policies Put Off Care, WI Public Radio

CIB: Maternal Depression Screening and Treatment: A Critical Role for Medicaid in the Care of Mothers and Children, Center for Medicaid and CHIP Services (CMCS)

Et Cetera: Memos & Updates


NEW: BadgerCare Plus Handbook, published February 16, 2016 in Release 16-01

Medicaid Eligibility Handbook (MEH), published Nov. 24 in Release 15-03. 

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.

Administrator's Memo 14-04, 2015 IM Consortia Administrative Allocation, has been published to the DHS web

Release 15-01 of the FoodShare Handbook was published

Ops Memos:
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 EHR Eligible Professional User Guide was recently revised and was posted to the ForwardHealth Portal on May 16, 2016. Revisions to the user guide include:

  • Instructions for Program Year 2015

  • Attestation for Modified Stage 2 Meaningful Use

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

Provider Memos:
2016-15: Information for Eligible Professionals Regarding Changes to the WI Medicaid Electronic Health Record Incentive Program for Program Year 2015
2016-16: Changes to Coverage Policy for Testing for Drugs of Abuse
2016-17: New Fingerprinting and Criminal Background Check Screening Requirement Due to the ACA
2016-18: Date of Service Defined and Documentation Requirements Clarified for Durable Medical Equipment and Disposable Medical Supplies

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: