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Vol. 11, No. 21 November 13, 2015

"Eleven Weeks To Go"

In this issue...

Big Announcement from HealthWatch: We are pleased to announce the dates of our 9th Annual HealthWatch Wisconsin Conference! Join us in Madison on April 6 & 7, 2016! Our conference has a NEW location as well! We will gather at the Madison Masonic Center as our regular, past location is being remodeled. We look forward to a full agenda, with many "Back 2 Basics" sessions for the rookie and seasoned professional alike! We also ask for your help: nominate a friend, coworker, or yourself for one of our HealthWatch Wisconsin Awards! Details are below!

Eleven weeks to go! Open Enrollment in Health Reform's Marketplace opened November 1, 2015 without the fanfare - or glitches - of past years. Also in this edition of the Update, we remind advocates of the important, impending Marketplace and Medicare Open Enrollment deadlines, as there are only 11 weeks left to get Marketplace coverage, and only 3 weeks left for Medicare Open Enrollment. Our popular "Bookmark It!" section includes, the updated "Advocate's Guide to MAGI," a publication of the National Health Law Program. We also share statistics on Open Enrollment released by CMS November 12. The results after the first week? Slow and steady. To gin up enthusiasm for enrollment, CMS also is sharing their "Theme Weeks" calendar, and we share that with you below.

We also review breaking headlines in today's Update newsletter, in addition to other news stories. All this and more, including a Q & A on custody and placement rules in BC+, a Marketplace Video Case Tip Library, important Ops Memos, Provider Updates and other ForwardHealth announcements, HealthWatch Coalition updates, and a few articles we enjoyed, and thought you might too! 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.

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!

In the Training Portal: Newsletter Table of Contents

Some of the news and analysis features added to the Training Portal as of November 13 includes:

  • Save the Date! HWW Annual Conference is April 6 & 7, 2016!
  • Packer Ticket Prize Drawing WINNER!
  • DHS Listening Sessions on Autism Treatment
  • Family Voices of WI Fall Training Schedule
  • Open Enrollment Status Report
  • ACA "Theme Weeks"
  • Medicare Open Enrollment Reminder
  • Heating Assistance
  • ACA Under Attack. Again.
  • Bookmark It! MAGI Guide
  • BadgerCare Plus October Enrollment Data
  • Rural Enrollment
  • Medicaid Expansion: Montana
  • Marketplace Video Case Tip Library
  • Coalition Corner: Information and Resources from Local HW Coalitions
  • Ask a Good Question...Custody and BC+ is this week's question!
  • Et Cetera: New Handbook links, Ops Memos & Updates
  • Headlines, and much more!

Members and paid subscribers, click here to login and view the Update online!

Not a member yet? No problem! Click here to register online and pay for your membership or subscription with a credit card. Or, you can print a registration form to mail or fax back to us (instructions provided on the form). If you would like to register over the phone or have questions about the registration process, please call 608-261-6939 ext. 218.

SAVE THE DATE: 9th Annual HealthWatch Wisconsin Conference

HealthWatch Wisconsin is pleased to announce our 9th Annual Conference will be held April 6 & 7, 2016 in Madison!

Please note: We have a NEW LOCATION this year! Due to a remodeling project at our usual conference hotel, this year's Annual Conference will be at the Madison Masonic Center, 301 Wisconsin Ave., Madison, WI.

Please mark the date on your calendar, and watch your inbox for registration instructions. In the meantime, HealthWatch Wisconsin is now accepting nominations for our annual awards! At our conference, HealthWatch will again include an awards ceremony to recognize outstanding efforts made in 2015. We need your help! Send us a nomination for a deserving person in one of our award categories:

  • Advocate of the Year
  • Elected Official of the Year
  • Outstanding Media Coverage
  • Outstanding Outreach Effort

Make your nomination today! Send an Email or Fax (608-261-6938) to HealthWatch with the following information:

  • Your Name & Contact info
  • The Award Nominee's Name and Contact Info
  • Which Award You are Nominating this person for
  • A few words why this individual/organization is worthy of the honor

Annual Call for Nominations to the HealthWatch Leadership Council!

Are you interested in being more involved in helping to guide project activities and trainings of HealthWatch Wisconsin? Each year, the membership of HealthWatch Wisconsin elects a new class of public health professionals to serve a three-year term on the HealthWatch Council. These leaders direct and amplify the powerful voice of the membership!

HealthWatch solicits nominations each fall from the membership-looking for people of diverse backgrounds and public-health-oriented professions. The last opportunity to submit nominations is at the Annual Conference in early 2016.

If you know someone you would like to nominate--or if you wish to nominate yourself, send us an email! Include your name, workplace, contact information, and the name of the individual you are nominating. Thank you!

Milwaukee "Building Blocks of Health Coverage Workshop" a Success!

Health Benefits Counselor Manager Anna Kaminski presents at the "Building Blocks" workshop as ABC attorney Laura Steigerwald looks on.

Thank you to everyone who joined us at the Medical College of Wisconsin on November 3 for the "Building Blocks of Health Coverage" workshop!

We are especially grateful to Regional CMS Outreach Lead Brenda Delgado who joined us from Chicago to open the day with updates and strategies in the first week of Open Enrollment. Brenda shared an overview of current outreach efforts to targeted populations- including young adults and rural communities.

ABC for Health staff presented detailed sessions on topics including Open Enrollment, Coverage Transitions, BadgerCare Plus Hot Topics, Appeals in Medicaid and the Marketplace, and Immigrant Health Coverage Considerations. Thank you to the Medical College of WI staff and facilities crew for a beautiful workshop venue and AV/Tech assistance!

Congratulations to our Prize Drawing Winner!

Congratulations to Dr. Anusha Priya, UW Medical Resident! You're our lucky HealthWatch Wisconsin Packers Ticket Prize Drawing Winner in our last drawing of the 2015-2016 membership year! Anusha will cheer on the Green Bay Packers as they play the Detroit Lions on November 15 at Lambeau Field! 

A HealthWatch membership provides valuable benefits such as electronic publications, on-demand training videos, and other resources through the HealthWatch Training Portal. We also offer substantial discounts on registration for trainings and workshops, including our upcoming 9th Annual Conference! Whether you are renewing last year's membership, or looking to join HealthWatch Wisconsin for the first time, you will not want to miss out!

For more information, give us a call at any time: 608-261-6939 ext 218
Other Events: Family Voices of WI Training Schedule

Family Voices of Wisconsin promotes a family voice in public policy, systems change and professional education. They develop information to help families stay informed about public policy issues and connect families and youth to leadership and advocacy opportunities, including holding listening sessions to hear from families about their experiences with health care and support services. They then share this important information with policy makers to work toward improving their systems of care. Family Voices of WI also provides face to face training workshops to families on navigating health and community supports. The training sessions, including the Did You Know? Now You Know! and What’s After High School training, are presented in communities throughout Wisconsin.

The Family Voices of WI Fall Training Schedule is now available: All sessions are free to participants and a resource binder and meal are provided. To learn more and to register go to the Family Voices website.

Other Events & Trainings: DHS Offering Training and Information Sessions Regarding Additions to Coverage of Autism Treatments

In 2014, CMS updated state Medicaid guidelines. Now, state Medicaid programs must cover autism treatment services as a regular benefit. In Wisconsin, programs like BadgerCare Plus, Elderly, Blind, or Disabled Medicaid, and the Katie Beckett Program will cover these services. The changes will take effect in early 2016. Services now covered and changes include:

  • Comprehensive Treatment: High intensity, early intervention treatment, which focus on multiple behaviors and development aspects in children.
  • Focused Treatment: Less intense, more sporadic, treatment addressing specific behaviors or developmental deficits.

In order to receive treatment, patients must first seek prior authorization from a health care provider, who deems the treatment as medically necessary.

The Department of Health Services has scheduled several regional meetings to help consumers and advocates learn about and share information regarding the newly covered behavioral treatments. In addition, two of the meetings have the option to participate via live webcam. This is especially helpful for individuals in rural areas, who would otherwise have to travel long distances.

Marketplace Open Enrollment Status Report!

We’re halfway through the first month of Marketplace open enrollment! Remember, Open Enrollment is SHORTER this year, running only until January 31, 2016. Individuals are encouraged to login to Healthcare.gov to shop, review plans, and sign up for coverage, or change your current plan sooner, rather than later. Individuals who wish to have coverage BEGIN January 1, 2016, without a gap, will need to have a plan selected by December 15th to avoid any gaps in coverage!

Remember, if you had Marketplace coverage through 2015 and "do nothing" you'll automatically enroll into the same plan for 2016, but CMS strongly encourages you to verify your information. Plan options and pricing often change each year. So, even if the plan you chose in 2015 was a "perfect fit," it may NOT be in 2016!

Also, you don’t need to start a new application to window shop. This year, the Centers for Medicare and Medicaid Services (CMS) has added new features that allow for a better “shopping experience.” You can enter your doctors, hospitals, and prescriptions to see the estimated costs of premiums, deductibles, and co-payments.

On November 12, CMS issued a press release that gave a snapshot of Federal Marketplace statistics after the first week of Open Enrollment.

(Login to continue reading.)

BadgerCare Plus Enrollment in October

BadgerCare Plus enrollment information for October 2015 was finally made available on the ForwardHealth portal and the data are actually OK. This is the first time we have seen overall enrollment in BadgerCare Plus be essentially UNCHANGED from one month to the next.

In September 2015, overall BC+ enrollment was at 803,096. In October, it was 803,100, a difference of FOUR PEOPLE! While we do not like to see a dip in Childless Adult enrollment, it was a small one, losing only about 200 people from September to October.Income Extensions grew again, continuing a trend that began in February of this year, gaining almost 3000 children and parents since September (and over 20,000 since February!!)There was a dip in children enrolled, down again for the seventh month in a row. It is possible some of these children are being picked up in the income extension category. BC+ lost over 1,300 children from the roster from September to October, (losing a total of over 16,000 since March of this year.)MAPP continues to grow (slow and steady) adding 145 since September continuing a 10 month trend of slowing adding enrollees. MAPP has gained 1300 since January, about 100 or so each month.

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Wisconsin Navigators:

  • Covering Wisconsin (formerly known as Covering Kids and Families): 608-261-1455
  • Northwest WI Concentrated Employment Program: 715-682-9141
  • Forest County Potawatomi Community: 715-478-7200

Bookmark It! Advocate's Guide to MAGI

The National Health Law Program (NHeLP) has released an updated "Advocate's Guide to MAGI." It walks advocates through ACA tax filing and reporting requirements while clarifying commonly asked questions. It also includes links to new IRS publications. From the NHeLP website:

"The ACA established new rules for counting income and family size to determine eligibility for insurance affordability programs, including subsidized health insurance through the Marketplaces, Medicaid and CHIP. These new MAGI rules are applicable nationwide and can be complex. NHeLP’s Advocate’s Guide to MAGI is our free resource designed to help advocates understand and apply these new income counting and household composition rules. The Guide explains in detail how MAGI works, including who is and who is not subject to MAGI, the types of income counted and excluded, and how to figure out who is in an applicant’s 'household' for determining eligibility."

Free Video Case Tip: Marketplace Video Case Tip Library

This month, we're featuring our "Marketplace" Video Case Tip Series! As you assist families, keep things like "gap fillers," Pregnant Women and the Marketplace," and "Penalties" in mind. Not sure how the rules and regulations fit with the family you're assisting? One of our short videos may help.

Health Reform's Marketplace
Open Enrollment in Health Reform's Marketplace
Data Matching Issues in the Marketplace
Special Enrollment Period from Income Counting Error
Shared Responsibility Penalty: Short Gap Exemption
Pregnant Women and the Marketplace
Open Enrollment 3.0
Increase in Income
Decrease in Income

Ask a Good Question...

My ex-husband and I are applying for BadgerCare plus for ourselves and our children. We have equal custody of our children, but we aren't sure who is able to include the children on our separate BadgerCare Plus applications?   

...Get a Good Answer: Login to the Training Portal to see the answer to this question!

Coalition Roundup

NOTE: Congratulations to Milwaukee HealthWatch Coalition on 25 years!! The December Milwaukee HealthWatch Coalition Meeting is a CELEBRATION! All are welcome as we celebrate 25 years of Milwaukee HealthWatch! Watch for details in early December.

Thank you! Dane County HealthWatch Food Drive:

In addition to our focus on Dane County health care access and coverage topics every year the Dane County HealthWatch Coalition holds a Food Drive at our November meeting – this meeting was on Monday, November 2 in Madison. Coalition members donated over 200 pounds of non-perishable food items! That makes over 600 pounds donated in the last three years alone. Thank you all!

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

Coalition Next Meeting Contact
Chippewa County TBD Rose Marsh
Dane County Dec. 7 Anna Kaminski
Eau Claire Jan. 7 Lou Kelsey
Milwaukee Dec. 9 Joanna Woodbury
Pierce County TBD Rebecca Tomasek
Polk County TBD Mike Rust
Tri-County Nov. 24 Connie Raether

Et Cetera: Memos & Updates


NEW: 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.

NEW: BadgerCare Plus Handbook, published September 2, 2015 in Release 15-02

Medicaid Eligibility Handbook (MEH), published July 30, 2015 in Release 15-02

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

Ops Memo 15-37 Wisconsin Shares Special Needs Higher Rate Request Form

Ops Memo 15-38 Promissory Notes as Assets

Ops Memo 15-39 New, Optional Provider Form for Medical Exemption from the Work Requirement for Able-Bodied Adults Without Dependents

Ops Memo 15-40 Identifying Depreciation and CC invalid Expenses on IRS Tax Forms

Ops Memo 15-41 Adjusted Self-Employment Income for Child Care

Ops Memo 15-42 Adjusted Self-Employment Income Authorization Calculation

Provider Memos

2015-51 Clarification of the Completion Instructions for the Consent for Sterilization Form

2015-52 Hospice Reimbursement Rate Changes

2015-53 Revised Hearing Aid Contract Models and Pricing Effective September 2015

2015-54 Changes to Process for Submitting Birth to 3 Program Claims

2015-55 Provider Enrollment for the New Behavioral Treatment Benefit

2015-56 Ambulatory Surgical Center Access Payments Discontinued for Fiscal Year 2015

2015-57 Prior Authorization Required for Paliperidone Tablets



California Fines Top Health Insurers for Overstating Obamacare Networks, Los Angeles Times

Doctors Seek to Block 2 Health Insurance Mergers, Insurance Journal

Market Continues to Evolve for ACA Insurance Plans, Milwaukee Journal Sentinel

Medicaid and Kynect, Facts as Bevin Eyes Cuts, The Courier Journal

White House Seeks to Ease Veterans' Acces to Care, The New York Times

Wisconsin Residents Pay More for Health Coverage: Report, WXPR Radio

Tell Us What You Think!

HealthWatch Wisconsin Update readers, we want to hear from you! What do you think of 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!

Help HealthWatch Wisconsin & ABC for Health with a Tax-Deductible Contribution!

Support ABC for Health as we pursue our mission of helping people in Wisconsin secure access to health care and coverage. Our staff works tirelessly with the thousands of families and individuals who contact our office each year. To continue, we do need your help and support. A tax-deductible financial contribution will support direct legal, advocacy, and education services to families in Wisconsin.

Copyright © 2015 ABC for Health, Inc. All rights reserved. No reprint without permission.

HealthWatch Wisconsin is a project of ABC for Health, Inc.
Update Staff:

  • Bobby Peterson, Executive Director
  • Brynne McBride, Chief Operating Officer
  • Matt Keller, HWW Membership Coordinator
  • Shannon Counihan, Student Intern