Vol. 12, No. 02
February 2, 2016
"Marketplace Enrollment CLOSED...Registration is OPEN!"
In this issue...
Open Enrollment in the Marketplace is now CLOSED, but registration is now OPEN for the 9th Annual HealthWatch Wisconsin Conference, "3 Steps to Health Care Coverage." See registration details below to take advantage of early bird pricing!
Now that Open Enrollment is closed, we look at some early enrollment data. Now, only individuals eligible for a Special Enrollment Period will be able to access the Marketplace-but the number of "Special Enrollment Periods" is shrinking. We summarize the new guidance coming out of CMS on this topic, and on another topic: Snowbirds! Actually, FAQs coming out of CMS now help individuals with more than one home determine residency for purposes of purchasing a Marketplace plan. At this time of year, snowbirds come to mind!
Also, now that the Feds have updated the Federal Poverty Level for 2016, the state has followed suit. The Ops Memo that gives effective dates for public benefits programs has been released. We share that below.
We share a short article on "On Demand FoodShare," dental access for children on Medicaid, and a new Rural Health News profile. We also include a new Video Case Tip, 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.
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9th Annual HealthWatch Wisconsin Conference Registration Now Open!
Early Bird Registration Rates Begin TODAY!
What: "3 Steps to Health Care Coverage" Conference
When: April 6 & 7, 2016 (come for one day or both!)
Where: Madison Masonic Center Ballroom, 301 Wisconsin Avenue
Click here to visit the Conference Registration Page
Who Should Attend: Advocates, social workers and nurse case managers, CACs, navigators, and assisters, insurance and HMO staff, Head Start, and still other people who help consumers access health care coverage and services!
HealthWatch Wisconsin's 9th Annual Conference is focused on ways to identify, optimize, and maintain coverage for individuals and families across Wisconsin, beginning with the basics of health coverage in Wisconsin, then intermediate policy and advocacy strategies.
What to Expect from the Two-Day Conference:
Day 1: Our conference begins with a "Back to Basics" workday on April 6. The day is perfect for beginners--those new to BadgerCare Plus, Medicaid & Disability Programs, Private Insurance and the Marketplace. But the program also helps seasond regulars who need an annual health coverage "tune-up!" The Back to Basics sessions will give a great overview of programs, advocacy strategies, and family stories that are useful to the beginner and experienced professional alike.
We'll then CELEBRATE the excellent work of health professionals across Wisconsin with our HealthWatch Awards Celebration! (It's not too late to nominate someone for Advocate of the Year, Outreach Effort, Media Story or an Elected Official. See details below.)
Day 2: Our conference continues on April 7 with a focus on what we're calling "Precision Patient Advocacy." You've heard of precision medicine-how to tailor individualized treatment to the unique medical needs of each unique patient. We think of coverage the same way. We'll talk about ways to identify and optimize coverage for each unique individual that looks at income, age, family size, and other unique markers of coverage, all while still keeping the busy workflow of your office in mind!
This second day of the conference also features a few of your favorite sessions from past years, including a legislative panel of your elected officials, and conversations with policy experts. New this year, you'll have the option to gather in the auditorium at the Madison Masonic Center to hear TED Talk-style presentations on challenging and inspiring health care and coverage hot topics!
Accommodations: All registrants are responsible for their own accommodations. We have made a few phone calls and reserved some hotel space at a discounted price. Please ask for the "HealthWatch Wisconsin" block of rooms when you call. See our registration form (bottom of first page) for hotel phone numbers and estimated prices.
Click here to visit the Conference Registration Page
TOP STORY: Marketplace is Closed*
Sunday marked the last day of the Health Insurance Marketplace 2016 Open Enrollment Period! As of week 12 of open enrollment 8.9 million U.S. consumers had signed up for health insurance through the Marketplace. In October, Health and Human Services Secretary, Sylvia Burwell, announced that the administration expected 10 million individuals to sign up. It appears that the final numbers could get very close to, if not surpass, that target!
Remember, consumers cannot sign up for private insurance outside of the open enrollment period. This holds true *unless they experience a major life event such as the birth of a child, job change, or marriage. Also, consumers who forgo purchasing a health insurance plan must pay a tax for any month they did not have minimal essential coverage. This year, that fee is $695 per adult and $347.50 per child. However, some consumers may qualify for an exemption. Consumers are exempt if they were uncovered for only one to two months of the year, or if the cost of obtaining health insurance is greater than 8% of their household income.
Didnít sign up for insurance by January 31st and donít qualify for a special enrollment period or exemption? You, or someone else in your household - such as a child, may still qualify for certain public health benefits depending on income, age, and other circumstances.
Remember: Medicaid and BadgerCare Plus Programs are always open for eligible enrollees! Parents and childless adults are eligible for Wisconsinís Medicaid program, BadgerCare Plus, if they are at or below 100% of the federal poverty level (FPL). In Wisconsin, children and pregnant women are eligible up to 306% FPL.
If you think you or someone in your household may be eligible for public benefits visit Access.wisconsin.gov to apply, or check out our video case tips to learn more about eligibility!
CMS issued a press release on January 27 that gave a snapshot of Federal Marketplace statistics after the first TWELVE weeks of Open Enrollment.
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TOP STORY: 2016 Federal Poverty Level Income Limits Updated
On January 25, the US Department of Health and Human Services updated the poverty guidelines, a task that is required by law to happen at least annually, based on the Consumer Price Index. They are used as an eligibility criterion for a number of community and federal programs.
In an Operations Memo issued January 28, 2016, the state Department of Health Services published the "2016 Federal Poverty Level Changes for ForwardHealth Programs." In a series of charts, the state outlines the effective date of the 2016 FPL number for each coverage program. The effective date for using 2016 FPL numbers for BadgerCare Plus is February 1, 2016. Caseworkers with clients who may benefit from the new guidelines should re-determine their eligibility with the 2016 FPL limits so they can receive lower premiums effective in February, rather than March. ABC for Health has updated its Federal Poverty Level Calculator to reflect the new numbers, which is helpful when determining eligibility for health coverage programs.
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Clearing up Residency Requirements for "Snowbirds"
At this chilly time of year, certain northerners have retreated southward to wait out the winter. This causes confusion for those purchasing insurance in the Insurance Marketplace. Where to you call "home?"
If you are someone who has more than one permanent home and is not sure where to establish residency, you are not alone! Luckily, CMS has recently released information in the form of "FAQs." First, to establish residency in a "service area of the Exchange" (that is, the state, or region, in which the Health Insurance Marketplace operates) one must either live in that service area, intend to reside there, or have job commitments at the location. If you have more than one home, then a key metric is the "length" of your visits. If you merely visit a secondary home for short durations of time, you are considered a resident of the service area of your primary home.
However, it is possible that someone could meet the residency requirements in more than one location by spending large amounts of time (such as full seasons) in two primary homes (such as the snowbirds we referenced above). In this case, CMS states that individuals are able to establish residency in either location, or both! In such a situation, CMS clarifies that individuals may qualify for a "permanent move special enrollment period" each time they move between Marketplace residencies. However, they might consider enrolling in a qualified health plan that offers national provider or out-of-network coverage instead. Below is a link to the CMS page containing even more information about residency! Check out CMS' FAQs on the issue for more information.
Voices & Views
Medicaid Expansion: Obama Administration Creates New Incentive For States To Expand
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. Medicaid expansion extends statesí Medicaid plans to individuals living at or below 138% of the federal poverty level (FPL), which many states fall well below. Texas, for example, covers parents living below 15% of the FPL (which equates to about $300 a month for a family of four) and does not cover able-bodied, childless adults. While the Presidentís plan may create some incentive to expand, he will need to get approval from Congress. The administration plans to release the proposal February 9th.
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Dental Care Lacking for Children With Medicaid
Childrenís Medicaid, or the Childrenís Health Insurance Program (CHIP), (included in BadgerCare Plus in Wisconsin) varies by state, but the federal government requires states to minimally cover regular procedures such as immunizations, check-ups, and dental care. Unfortunately, many parents are finding it difficult to locate dental providers who accept CHIP or BadgerCare Plus as payment for routine dental visits and other procedures. This is nothing new, but for many families in Wisconsin, they are tired of the wait. They are not alone.
A recent report released by the Department of Health and Human Services (HHS), titled, "Most Children With Medicaid in Four States Are Not Receiving Required Dental Services," states that 75% of children within the states of California, Indiana, Louisiana, and Maryland did not receive required dental services, and 25% of children, covered through CHIP, were unable to see a dentist, period. Ignoring dental issues can lead to costly interventions down the road as the report states: "When children lack dental care, untreated decay and infection in their mouths can result in preventable emergency room visits or more complicated and expensive dental and medical interventions late in life." Beyond tooth decay, untreated dental issues can also lead to chronic diseases such as heart disease and diabetes.
If dental care is such an important aspect of long term health, why are so many of these children going untreated? HHS studied a number of states and identified many barriers to dental care.
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In this week's "Bookmark It!" section we re-visit the ABC for Health FPL Calculator-a useful link that was featured in this newsletter not too long ago. But, as the FPL chart has JUST been updated by the Federal Government, so too has the calculator! Remember to Bookmark the calculator (or "refresh" your page so the correct calculator is shown) to take advantage of this useful tool!
Also remember: the Marketplace and Medicaid use different FPL tables. The Marketplace will look at an individuals 2015 income when determining eligibility for 2016 coverage. (There is access to the 2015 FPL numbers on the bottom of the FPL Calculator page.)
Watch This! Pregnant Women and the Marketplace
What happens when a woman enrolled in a Marketplace plan becomes pregnant--and is eligible for BadgerCare Plus as a pregnant women? We look at this - and a few other related scenarios - in this week's featured Video Case Tip: Pregnant Women and the Marketplace!
Women who are pregnant are eligible for the BadgerCare Plus Standard Plan (up to 306% FPL) under MAGI rules. Women who are over this limit can become eligible by meeting a deductible. Pregnant women are also eligible for coverage through the Marketplace (between 100 - 400% FPL).
If a pregnant woman qualifies for BadgerCare Plus, she will not have to purchase a Marketplace plan, and then would also not have to pay a penalty for not having coverage.
Someone who qualifies for either employer-sponsored insurance or BadgerCare Plus could get a plan through the Marketplace, however they would not be eligible for assistance with premium tax credits. Pregnant women are also not subject to access to coverage rules in BadgerCare Plus, and could potentially be eligible for assistance with premium tax credits, in addition to Marketplace and BadgerCare Plus plans.
Each informative video from our Video Case Tip Library includes links to resources or more information!
You can watch these videos at any timeótheyíre on-demand and available wherever there is an internet connection.
3 C's for CYSHCN! "Competency, Capacity, & Coordination"
Family Voices of Wisconsin Events & Trainings
Family Voices of Wisconsin is a local agency focusing on educating families and providing them with the tools to make informed decisions regarding health care for youth with special health care needs or disabilities. Family Voices is holding two events this spring focusing on training and advocacy. The organization will host these events around the state from February to May, so make sure to attend!
Trainings for Families and Providers:
Did You Know? Now You Know! explains resources and services for children with disabilities and special health care needs from birth through young adulthood. Learn about health insurance and how to best use your benefits, Medicaid, long-term supports and community resources.
Whatís After High School? is a broad overview of the transition to adult life for youth with disabilities and special health care needs and includes the following topics: envisioning a youthís future in the community; the role of schools; long-term supports; transitioning to adult health care; legal options; advocacy; and the fundamentals of self-determination.
Visit Family Voices of Wisconsin or Login to the Training Portal to see more details on these trainings.
Rural Corner: Topics of Interest to Rural WI
Lawmakers Look at Rural Initiative
On January 14th, a coalition of Lawmakers introduced the Rural Wisconsin Initiative, which aims to create and foster more opportunities in rural Wisconsin. The seven part plan includes increased funding in areas such as technology, education, and health related fields. The plan proposes an increase in funding to the Wisconsin Rural Physician Residency Assistance Program (WRPRAP) in order to attract young doctors to more rural hospitals. In addition, the plan expands funding to obstetrics and gynecological training for physicians in order to address disparities in womenís access to equitable care. The lawmakers have also asked their constituents to share their own ideas for improvements to further benefit rural Wisconsin. Learn more at: legis.wisconsin.gov/assembly/republicans/ruralwisconsininitiative
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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.
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 new leaders 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!
2015 HealthWatch Wisconsin Awards Nominations:
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
For more information email your local HealthWatch Coalition contact below, or email us
Tax Scams are Targeting the Uninsured, NY Times
CMS Proposes Changes to ACO Benchmarks, Modern HealthCare
In the Marketplace Some People May Not Be Able to Purchase the Second Lowest Cost Silver Plan, Health Affairs Blog
ACA Updates: Important Deadlines and Changes, OCI
CBO Lowers Marketplace Enrollment Projections, Increases Medicaid Growth Projections, Health Affairs Blog
Clarifying, Eliminating, and Enforcing Special Enrollment Periods, CMS
CMS Releases Guide to Preventing Readmissions Among Racially and Ethnically Diverse Medicare Beneficiaries, CMS
Covered Outpatient Drugs Final Rule with Comment and Fact Sheet, CMS
Making the Affordable Care Act More Affordable, Madison Commons
Many Children with Medicaid Not Getting Required Dental Care, The Washington Post
Medicaid and Chip Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey, Kaiser Family Foundation
Using Travel as a Teaching Tool, and a Lever for Change, Health Affairs Blog
Et Cetera: Memos & Updates
NEW: Medicaid Eligibility Handbook (MEH), published Nov. 24 in Release 15-03.
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 FoodShare Handbook was published
Ops Memo 15-53: Updates to the FoodShare Clock and New Time-Limited Benefit Notification Letter Sample Time Limited Benefit Notification Letter
Ops Memo 15-J9: Policy and System Changes as a Result of Same-Sex Marriage Rulings
Ops Memo 15-54: Wisconsin Shares Policy Manual Updates to Chapter 1
Ops Memo 16-01: 2016 Federal Poverty Level Changes for ForwardHealth Programs
2016-01: Clarifications to Nursing Home Bedhold Policy
2016-02: Changes to Claims Submissions Requirements for Outpatient Hospital Services
2016-03:ForwardHealth Expanding Member Eligibility for HIV/AIDS Care Coordination Benefit
2016-04: New and Clarified Policy Regarding Submission of Prior Authorization Requests and Claims for Hearing Instruments
2016-05: 2016 CPT and HCPCS Procedure Code Changes
2016-06: Prior Authorization Required for Generic Imatinib Tablets
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
Matt Keller, HWW Membership Coordinator
Shannon Counihan, Student Intern