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Core Plan Enrollment Plummets!

As the Wait List Skyrockets to over 128,000 People

After peaking in January of 2010 at 65,265 members, March 2012 enrollment in the BadgerCare Plus Core Plan for childless adults sank to the lowest point yet--just 26,808. But despite the program's plummeting enrollment numbers, the Department of Health Services (DHS) has yet to open the program to new enrollees. The Wait List, which recently topped 128,706 childless adults, includes about 30% of Wisconsin's uninsured adults (based on Kaiser's most recent State Health Facts). According to the DHS Core Plan website, individuals on the Waiting List "will be able to enroll in the Core Plan as space becomes available." When DHS established the Core Plan Wait List in October 2009, there were approximately 46,000 childless adults enrolled in the program: How much more space does DHS need to start enrolling people in the Core Plan again?

Click here or on the chart below for Core Plan enrollment data!

Regular HealthWatch Wisconsin Update readers are familiar with our Wait List counter (see below), a recurring feature that has tracked the growth of the Core Plan Wait List since September 2011. In the seven months since the counter's debut, more than 20,000 people were added to the Wait List, an increase of approximately 20%. Remember, that's 20% even after more than two years passed in which the program took no new enrollees!*

(*Except for those with cancer who were able to take advantage of the Wait List Cancer Bypass from July 2010-March 2011, and those with chronic health conditions who were able to take advantage of a more robust Wait List Bypass from December 15, 2010-March 2011, before DHS discontinued the Bypass option altogether in March 2011, while also freezing the Basic Plan enrollment.)

CORE PLAN STORIES: Do you have a story about the BadgerCare Plus Core Plan? Were you or a client dropped from the program? Do you know people stuck on the Waiting List, uninsured and unrepresented? Please contact HealthWatch Wisconsin with your Core Plan Stories!

Health Care Segregation in Wisconsin

Core Plan Waiting List Adds More Than 100 People Each Day!

Below is our usual demonstration of the Core Plan Waiting List as a counter. This number represents the latest number we have of childless adults in Wisconsin on the BadgerCare Plus Core Plan Waiting List. HealthWatch maintains that the Department of Health Services/ Enrollment Services Center should screen applicants and help identify coverage options for these people, including, but not limited to, Elderly, Blind and Disabled Medicaid, Medicaid Assistance Purchase Plan, HIRSP, or SSI/SSDI.

Vol. 8, No. 8
May 1, 2012

In This Issue:

Core Plan Enrollment Plummets!

Health Care Segregation in Wisconsin

Core Plan News for Milwaukee (GAMP)

HealthWatch Wisconsin Member News

National HealthCare Decisions Day

MLR: Unreasonable Rate Increases

National Autism Awareness Month

Tell Your BadgerCare or Medicaid Story!

Grapevine: Medicaid Waiver

Grapevine: Applying for Medicaid Disability

Tax Tip: The New Health Insurance Tax Credit

Tax Tip: Changes to Earned Income Credit

NEW Video Case Tip: Your Little Dividend

Et Cetera: Announcements, Handbooks, & Memos

Coalition Roundup

3 C's for CYSHCN!

Headlines

On our Website:
HealthWatch Membership
Upcoming Coalition Meetings

Footage of Public Hearings: The Human Impact of BadgerCare Plus

Follow @HealthWatchWi

One hundred twenty eight thousand, seven hundred and six people, and counting... (as of April 13, 2012)

Special thanks to Julie Baryluk of the Polk County Health Department and Rhonda Stuart of Northern Health Centers, Inc. for continuing to sign people up for the Core Plan Wait List! And remember, if you sign someone up for the Core Plan, let HealthWatch know what number they are on the Wait List, so we can keep our counter as accurate as possible!

Core Plan News for Milwaukee (GAMP)

The GAMP Factor and Core Plan Renewals

In January 2009, individuals in Milwaukee County who were participating in the General Assistance Medical Program (GAMP) were automatically enrolled by the State of Wisconsin in the BadgerCare Plus Core Plan. This population of approximately 12,000 individuals was referred to as the “Transitional Childless Adult Population,” (TCLA) to distinguish them from those individuals across the state that elected to enroll in the Core Plan in mid-2009. In March, April and May of each year, this TCLA population must renew their Core Plan benefits and pay the required $60 to keep benefits. Since the TCLA population was automatically enrolled in this benefits program from the start, the enrollees may not be aware of any of the application or renewal logistics. You can help inform or remind individuals to renew their benefits! Renewal applications must be submitted in the “renewal month” or the following month. Verification and the payment of an annual non-refundable fee of $60 is required as well (with the only exception being those that meet the HUD definition of homeless). If not submitted in time, the individual will have to apply for the ever-growing waiting list. For the balance of the Core Plan enrollment population-those outside of TCLA, renewals are fast approaching as well. Start talking to individuals now about their summer 2012 renewal dates of June-October.

HealthWatch Member News

Welcome New Members of the HealthWatch Wisconsin Council!

The results of the 2012 HealthWatch Wisconsin Council Elections are in! Although many of this year's nominees received a respectable number of votes, HealthWatch members have made their voices heard, choosing the following candidates more times than all the rest. Please help us congratulate the new members of the HealthWatch Wisconsin Council:

Theresa Fosbinder, Planned Parenthood of Wisconsin
Frank Robinson, Children's Hospital of Wisconsin
Eric Gass, City of Milwaukee Health Department
Meghan Pesko, MD, Waukesha Family Medicine Residency Program
Debbie Stein, Brown County Health Department
Re-elected: Chris Okunseri, Marquette University Dental School

The HealthWatch Wisconsin Council serves as the advisory committee for the HealthWatch Wisconsin organization and helps guide the project’s activities. The Council provides leadership and advice to HealthWatch Wisconsin as we work to transform the public health landscape and increase access to care and coverage for people in Wisconsin through training, education, and collaborative partnerships.

HealthWatch members voted for the new Council members in person at the Fifth Annual HealthWatch Conference at the end of February, and those members unable to attend the conference submitted ballots electronically. Those not in attendance responded to an emailed ballot. Upon the closing of the voting period, the winners were formally adopted by the HealthWatch Executive Committee. The three-year term for each new Council member will officially begin on July 1, 2012, to coincide with the new membership year of HealthWatch Wisconsin. The next meeting of the full Council will be in October 2012. Help us welcome these new members to the Council!

The New HealthWatch Wisconsin Membership Year Coming on July 1!

Remember, HealthWatch Members, the election of new HWW Council members means that the new membership year is coming up quickly! Please keep an eye out for renewal materials in the mail and email, as well as special promotions for the new membership year!

Membership benefits include access to the HealthWatch Wisconsin Training Portal, which now features PDFs of all current HealthWatch Wisconsin publications, as well as useful trainings on Wisconsin's public and private insurance programs, key rules to know, and much more!

HealthWatch members can currently access the following publications on the Training Site:

3 Steps to Family Health Coverage
The AdvoKit for BadgerCare Plus Coverage
Monthly Income Eligibility Chart (2012)
The HealthWatch Toolkit
My Medical Debt Survival Guide
My Health Insurance Guidebook
My Health Reform Guidebook
Non-Qualified Immigrant Programs Chart
Medicaid/BC+ Programs Chart

Not a member of HealthWatch Wisconsin? What are you waiting for? Remember that our members qualify for Green Bay Packer club seat ticket drawings, discounted publications trainings and more! For information on joining click here

April 16 is National HealthCare Decisions Day!

April 16 has been designated “National HealthCare Decisions Day” by the governor and other state and national leaders. As you talk to families about appropriate care and coverage options this week, take some time to consider your own future medical care wishes. This can be as simple as discussing your medical desires with family, friends, or healthcare providers or as involved as filling out an advance directive document.

In Wisconsin, competent adults have the right to control decisions about their future medical care, including the right to accept or refuse treatment and the right to choose whether or not to become an organ and tissue donor. In spite of this legal right, an estimated 80% of residents have NOT documented their preferences through advance directives.

Two of the basic advance directive documents are the living will and the durable power of attorney for health care. These are legal documents that allow individuals to give critical medical information and directions to their healthcare providers, healthcare agent, and family/friends about their wishes. Click here to see these forms.

In addition to checking the boxes designated on the form, individuals should take some time to consider their wishes and talk with their family and their doctor. National HealthCare Decisions Day aims to ensure that individuals' wishes are respected, whatever they may be. Click here to learn more.

Wisconsin Health Insurance Rate Hikes Deemed Unreasonable

Medical Loss Ratio Follow up:

As first reported in the Wisconsin Health News, HHS Secretary Kathleen Sebelius declared a 24 percent rate increase by Time Insurance Company for nearly 17,000 individuals in Wisconsin is "unreasonable." In our last Update newsletter, we included a March 22 press release by HHS that identified many excessive rate hikes by insurance companies, including a 24 percent increase by John Alden Life Insurance Company, also owned by Assurant, that will impact nearly 700 people. Both increases will go into effect on May 1.

Resources for National Autism Awareness Month

April is Autism Awareness Month! This campaign to highlight and educate the public about autism and issues within the autism community has been celebrated nationwide since the 1970s. For resources and to learn more, click on some of the links we’ve highlighted below:

HHS Autism Portal: http://www.hhs.gov/autism/

The New York Times: Gene Studies of Autism Point to Mutations and Parents’ Age

Center for Disease Control: CDC estimates 1 in 88 children in United States has been identified as having an autism spectrum disorder

PBS Point of View: A Neurotypical's View On Autism Documentaries

Tell Your BadgerCare or Medicaid Story

At the 5th Annual HealthWatch Wisconsin Conference, attendees heard Rep. Roys, Rep. Mason, Rep. Hulsey, and Rep. Richards encourage the state, legislature, and governor to do more listening. They encouraged the people of Wisconsin to share their voices, be involved in the process, and tell lawmakers why BadgerCare and Medicaid are important. Now's your time to RAISE YOUR VOICES!

Are you one of the nearly 125,000 childless adults stuck on the Core Plan Wait List?
Are you a mother or father just making ends meet who's concerned about the effects of the proposed Alternative Benchmark Plan on your child's BadgerCare coverage?
Do you worry about the possibility of losing access to Family Planning Only Services?
Do you have another health care issue that needs to be brought to attention of DHS officials and policymakers?

CLICK HERE to complete a story form and email it to ABC for Health or call and talk to one of our advocates (608) 261-6939 ext. 229 and let them know you are calling to tell your BadgerCare story!

Grapevine

Answer Coming Soon on Wisconsin's Medicaid Waiver Request?

In a recent interview with Tim Stumm of Wisconsin Health News, Federal Department of Health and Human Services (HHS) Secretary Kathleen Sebelius estimated HHS was just weeks away issuing a decision on the changes proposed by DHS to Wisconsin's Medicaid programs for non-pregnant, non-disabled adults over 133% FPL. The March 15 edition of the HealthWatch Update newsletter covered the Joint Finance Committee hearing on these proposed changes. Because the states do not need an MOE waiver to alter the eligibility for this population, DHS hopes to implement these changes beginning July 1.

The changes, mostly premium increases for these low-income adults, were summarized in a Legislative Fiscal Bureau memo, sent to Joint Finance on March 14, 2012.

Having Trouble Applying Online for a Medicaid Disability Program?

The Medicaid online application site. www.access.wi.gov now allows an individual to apply for Elderly, Blind and Disabled Medicaid via the online site, even if they do not have a disability determination from the Disability Determination Bureau. In the past, only someone with a disability determination could use the website, and individuals without a disability determination were limited to paper applications for both Elderly, Blind and Disabled Medicaid (which collects income and asset information) and the Medicaid Disability Application (which collects the medial information.) This change was announced in Operations Memo 12-19.

Since the effective date of the change, March 29, 2012, individuals have struggled with the new process. The Grapevine wants to know what problems have you encountered or what strategies have you employed to make this new process easier for clients? See the snapshots of Access.gov for a better idea of what the new changes look like for someone applying online.

Tax Tip for Small Businesses

New Health Insurance Tax Credit for Small Businesses

Attention small businesses and non-profits--you still have a chance to cash in on a health care reform provision reserved just for you: health care tax credits. To be eligible, you must cover at least 50% of the cost of single (not family) health care coverage for each of your employees. You must also have fewer than 25 full-time equivalent employees (FTEs). Those employees must have average wages of less than $50,000 a year. For tax years 2010 through 2013, the maximum credit is 35% for small business employers and 25% for small tax-exempt employers such as non-profits and charities. (Note: In 2014, that will jump to 50% and 35%, respectively.)

How do you claim the credit?

You must use Form 8941, Credit for Small Employer Health Insurance Premiums, to calculate the credit. If you are a small business, include the amount as part of the general business credit on your income tax return. If you are a tax-exempt organization, include the amount on line 44f of the Form 990-T, Exempt Organization Business Income Tax Return. You must file the Form 990-T in order to claim the credit, even if you don't ordinarily do so.

Already Filed Your Taxes? Even if you have already filed your taxes for 2011, it may be worth the effort to file an "amended return" to claim this tax credit. Is it worth it? Consider the following example from the IRS website:

"Here’s what this means for you. If you pay $50,000 a year toward workers’ health care premiums – and if you qualify for a 15% credit, you save … $7,500. If you save $7,500 a year from tax year 2010 through 2013, that’s total savings of $30,000. If, in 2014, you qualify for a slightly larger credit, say 20%, your savings go from $7,500 a year to $12,000 a year."

Tax Tip for Low-Income Consumers

Changes to Earned Income Tax Credit

In Governor Walker’s budget the General Fund Tax Omnibus, introduced by a GOP motion on general fund taxes, was approved and incorporated into the final budget. Offering tax cuts to some corporations while cutting back the Earned Income Tax Credit benefits for low income families, the budget decreased the percentages for claimants with two children from 14 percent to 11 percent, and decreased the percentages for claimants with three or more children from 43 percent to 34 percent.) (LFB paper 312) The Wisconsin State Journal reports that this year, “Wisconsin cut the amount of credit available to such taxpayers by $27.3 million to $113.3 million. The Legislature reduced the projected credit for next year by $28.9 million to $119.5 million. The state also stopped adjusting the homestead tax credit for inflation, saving an estimated $3.1 million this fiscal year and $10.5 million next year. In 2011, the state paid $132.9 million in homestead tax credits…. Under the changes in the state's earned income tax credit program, a single mother with three children earning minimum wage will lose out on about $518 when filing for the credit this year, a roughly 20 percent reduction from 2010, according to the Wisconsin Council on Children and Families.”

NEW: Video Case Tip - Click the Image to Play

Your Little Dividend: Claiming Newborns and Children at Tax Time

Tax time means counting the number of dependents in your family group. Generally speaking, personal exemptions include all dependent children that you support. Others may be eligible to claim the child tax credit, the child and dependent care credit and the earned income tax credit. Unmarried individuals with a dependent may be eligible to file as head of the household. Therefore, be careful about whether you can really claim the dependent on your tax return. Note that under most circumstances parents may claim a baby born any time during the tax year as a dependent. In Publication 501, the IRS explained more specifically that “A child who was born or died during the year is treated as having lived with you all year if your home was the child’s home the entire time he or she was alive during the year.”

(Note: The IRS does not consider stillborn babies as dependents under this rule. To be countable as a dependent, the baby must have been alive at some point during the year.) The IRS will make an exception to their rule requiring the child to be in the parent’s home for a babies hospitalized after birth for some time.

EXAMPLE: Jim and Susan had a baby girl on September 2, 2011. The baby was admitted to the Neonatal Intensive Care Unit for 2 ½ months after birth. When Jim and Susan complete their 2011 tax return, they will be able to claim their daughter for all of 2011, even though the baby was born toward the end of the year and was out of the family’s home for 2 ½ months after birth. Please see the IRS publication online at http://www.irs.gov/publications/p501/ar02.html#d0e3591 for more information on these rules.

Et Cetera: Announcements, Handbooks and Memos

Provider Updates

2012-16	New Address for ForwardHealth's Fiscal Agent, 4/3/12
2012-15	Hospital Pay for Performance Changes, 4/3/12
2012-14	Change to Reimbursement for Consultation Services, 3/27/12
2012-13	Reimbursement Reduction to Professional Services Providers for Certain Services When Provided in a Hospital or Ambulatory Surgery Center, 3/27/12
2012-12	ForwardHealth Coverage of Computer-Based Testing of Student Athletes for Post-Concussion Syndrome, 3/23/12
2012-11	New Service Modifier for Speech and Language Pathology Services, 3/22/12
2012-10	Therapy Service Modifiers to Be Used by School-Based Services Providers, 3/22/12
2012-09	Reporting Fraud and Abuse, 3/21/12
2012-08	Procedure Code Changes for Family Planning Only Services, 3/21/12
2012-07	Spring 2012 Pharmacy Policy Changes, 3/9/12

Joint Finance Committee

DHS Report to JFC on BadgerCare Plus Basic
Mar. 27, 2012
Detailed enrollment statistics for BC+ Basic as of January 2012.

DHS to JFC - Study: Feasibility and Fiscal Impact of Requiring a Photo on ForwardHealth Card
Mar. 22, 2012

Medigap and Medicare Part D Helpline Consolidation
Mar. 13, 2012
Request by the Department of Administration to merge Medigap and Medicare Part D hotline services.

Wisconsin Administrative Register

CR 12-025
AN ORDER to create DHS 115.05 (3), relating to fee for screening newborns for congenital and metabolic disorders and other services. Submitted by Department of Health Services.

Federal Register

2012-8071: Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2013 and Other Changes
Apr. 12, 2012
This final rule with comment period revises the Medicare Advantage (MA) program (Part C) regulations and prescription drug benefit program (Part D) regulations to implement new statutory requirements; strengthen beneficiary protections; exclude plan participants that perform poorly; improve program efficiencies; and clarify program requirements. It also responds to public comments regarding the long-term care facility conditions of participation pertaining to pharmacy services.

2012-8534: Truth in Lending (Regulation Z) [Comment period ends June 11, 2012]
Apr. 12, 2012
The Bureau of Consumer Financial Protection (Bureau) is proposing to amend Regulation Z, which implements the Truth In Lending Act, and the official interpretation to the regulation, which interprets the requirements of Regulation Z. Regulation Z generally limits the total amount of fees that a credit card issuer may require a consumer to pay with respect to an account, limiting fees to 25 percent of the credit limit in effect when the account is opened.

2012-8179: Request for Information on Prescription Medication Adherence [Comment Request, Deadline May 7, 2012]
Apr. 5, 2012
The Office of the Assistant Secretary for Health is seeking information about causes, impact and potential solutions associated with the public health problem of prescription medication non-adherence in adults with chronic conditions. The purpose of this notice is to provide individuals and organizations with the opportunity to identify issues relevant to all levels of government, as well as individuals, health care providers, and industry and private organizations in efforts to improve medication adherence in adults with chronic conditions.

2012-7916: Fair Credit Reporting Act Disclosures
Apr. 3, 2012
The Bureau of Consumer Financial Protection (“Bureau”) announces that the ceiling on allowable charges under Section 612(f) of the Fair Credit Reporting Act (“FCRA”) will increase from $11.00 to $11.50 effective April 3, 2012. The Bureau is required to increase the $8.00 amount referred to in Section 612(f)(1)(A)(i) of the FCRA on January 1 of each year, based proportionally on changes in the Consumer Price Index (“CPI”), with fractional changes rounded to the nearest fifty cents.

2012-7684: Nonpayment of Benefits to Fugitive Felons and Probation or Parole Violators [Proposed Rule]
Mar. 30, 2012
Withdrawal of the Notice of Proposed Rulemaking for Nonpayment of Benefits to Fugitive Felons and Probation or Parole Violators, effective March 30th.

2012-7701: Medicare and Medicaid Programs; Renewal of Deeming Authority of the Accreditation Association for Ambulatory Health Care, Inc. for Medicare Advantage Health Maintenance Organizations and Local Preferred Provider Organizations
Mar. 30, 2012
This notice announces the proposal to renew the Medicare Advantage “deeming authority” of the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) for Health Maintenance Organizations and Preferred Provider Organizations for a term of 6 years. This new term of approval would begin July 11, 2012, and end July 10, 2018. This notice announces a 30-day period for public comments on the renewal of the application.

2012-7699: Medicare Program; Renewal of Deeming Authority of the Utilization Review Accreditation Commission for Medicare Advantage Health Maintenance Organizations and Local Preferred Provider Organizations
Mar. 30, 2012
This notice announces the proposal to renew the Medicare Advantage “deeming authority” of the Utilization Review Accreditation Commission (URAC) for Health Maintenance Organizations and Preferred Provider Organizations for a term of 6 years. This new term of approval would begin May 26, 2012 and end May 25, 2018. This notice announces a 30-day period for public comments on the renewal of the application.

Coalition Roundup

Click here for a list of upcoming coalition meetings. Thanks to all of the coalition chairs who were able to present at the HealthWatch member meeting at the conference!

The Chippewa County HealthWatch Coalition met on Tuesday, March 13 at the Chippewa County Courthouse. Keri Milbrandt of the Chippewa County Birth-to-3 Program spoke to the group about primary coaching. Chippewa County HealthWatch has also provided support for the neighboring Eau Claire County HealthWatch Coalition with recruitment and outreach as it undergoes transition in 2012. The next Chippewa County HealthWatch meeting is on May 8 - mark your calendars now! For more information about the Chippewa County HealthWatch Coalition, please contact Rose Marsh.

The Dane County HealthWatch Coalition met on Monday, April 2 at the Waisman Community Outreach Center in Madison. Lynn Brady, executive operating officer of the Journey Mental Health Center (formerly ) in Madison came and spoke to the coalition about the many improvements Journey has made in the last couple years, as well as current services, capacity, and some goals for the future. Dane County HealthWatch also came together to donate toiletries, cleaning supplies, and other needed items to The Road Home, which provides housing assistance for some of Madison's neediest citizens--homeless families and individuals. The coalition briefly discussed collectively commenting on the developing Dane County ADRC, as well as the usual concerns related to transportation through LogistiCare. The next Dane County HealthWatch meeting will be on May 7, speaker TBD. The coalition will also plan some fun events for spring and summer, so stay tuned to the Coalition Roundup for more information! For more information about Dane County HealthWatch, please contact Adam VanSpankeren.

The Eau Claire HealthWatch Coalition has its next meeting coming up on Thursday, May 3rd at the Luther Hospital Cafeteria (Dining Room 1). Jessica Barrickman from Lutheran Social Services of Wisconsin and Upper Michigan, also a statewide individualized Community Support and Day Services Manager, will speak about Lutheran Social Services and the support they provide to organizations in Wisconsin. Miranda Hotter, Prevention Program Coordinator and Care Transition Coach for the ADRC in Eau Claire will also be speaking, informing coalition members about the New Care Transitions Program. Coalition chair and coordinator Lou Kelsey of the Epilepsy Foundation continues to manage affairs for the Eau Claire HealthWatch coalition. If you are interested in participating in Eau Claire County HealthWatch in 2012 or want more information, please contact Lou Kelsey.

The Milwaukee HealthWatch Coalition met on April 11 at Aurora Family Services in Milwaukee. Speakers Tyanna McLaurin and Tyler Weber from the Lindsay Heights Neighborhood Health Alliance spoke to the coalition about their organization and their many initiatives to restore and improve the Lindsay Heights Area. Adam VanSpankeren of ABC for Health presented as well, and elicited the group's feedback on HealthWatch Wisconsin events and membership benefits. Milwaukee HealthWatch's bimonthly meeting schedule continues, and coalition coordinator Julie Dixon-Seidl is doing an excellent job keeping everyone connected and informed, actively distributing resources and announcements to coalition members between meetings. The next Milwaukee HealthWatch meeting is Wednesday, June 13 and the agenda will include the Free and Community Clinic Collaborative and more. If you would like more information on Milwaukee HealthWatch, please contact Julie Dixon-Seidl or (414) 773-4646.

The Pierce County HealthWatch Coalition will meet next on May 17, at the Crossroads Community Church in Ellsworth. Nick Licary of LogistiCare will speak to coalition members about current happenings with LogistiCare and non-emergency medical transportation in northwest Wisconsin. Mark your calendars now! To RSVP for that meeting or for more information about the Pierce County HealthWatch Coalition, please contact Lisa Raethke.

The Polk County HealthWatch Coalition has devoted its energy to a virtual free clinic project, called “Chronic Care Plus of Polk County.” The project works to enroll low income uninsured adults with chronic diseases that need regular medical management. The typical patient will have about four medical management visits each year along with routine testing and for some, acute care visits that relate to the chronic disease that qualified them for participation in the free clinic. Polk County HealthWatch members will manage the intake, case review, medical center referral, and benefits counseling case management features of the program. For more information on the status of the Chronic Care Plus of Polk County project, contact Mike Rust.

The Tri-County HealthWatch Coalition last met on March 20, when coalition leadership reported on topics discussed at the 5th Annual HealthWatch Wisconsin Conference. The coalition also engaged in coalition building discussions to promote sustainability and the form connections with other community agencies. The next Tri-County HealthWatch meeting is coming up next Tuesday, April 24 from 9:30-11:30am and will be back at the coalition's original location at the Goodwill Community Center (1800 Appleton Road) in Menasha. The meeting will include a round table discussion of offered services and resources in the Fox Valley area. For more information about the Tri-County HealthWatch Coalition, contact Susan Garcia Franz or Connie Raether.

3 C's for CYSHCN!

"Competency, Capacity, & Coordination"

Ask a Good Question...

“My child is on my private insurance plan offered through my job. She has a lot of therapy needs, a lot of which are not covered by my plan. To make matters worse, all her specialty providers are out of town. We end up going “out of network” for most treatments, so are paying for a lot of her care “out of pocket.” How can we get some relief before going deeper into debt?

...Get a Good Answer!

The first step is to check your insurance to make sure the coverage is correct and that your insurer paid the claims correctly, according to your policy. Make sure you ask questions and if needed, file an appeal or grievance. Next, after you have confirmed that coverage through your insurance is unavailable, check to see if your child is also eligible for BadgerCare, Katie Beckett, or other Medicaid coverage.

In these coverage situations, the Medicaid program will be the secondary payor to the private coverage. Secondary coverage can dramatically increase access to medical services, especially for a family with extenuating medical needs, such as numerous therapy visits. Keep in mind that secondary or supplemental insurance will not pay the medical bills if the individuals has “broken” the rules of their primary insurance. Going “out of network” without a proper referral is a costly mistake that some families make. Under health reform, starting in 2014, individuals will have their out-of-pocket liabilities capped at certain amounts depending on FPL.

CYSHCN Resources:

Featuring a new Q & A unique to working with children and youth with special health care needs, information on upcoming trainings exclusive for CYSHCN collaborators, and a calendar.

Example: Jayne and Jim have private coverage through Jayne’s job at the bank. Their daughter, Suzie, has a rare genetic disorder that has started to impact her speech and gait. Suzie is covered by her mom’s health insurance, but that benefits plan limits certain therapy services. Depending on the family’s income, Suzie could consider an application for BadgerCare Plus. If the household’s monthly income is under 150% FPL, there will be no bar to having private coverage and BadgerCare Plus at the same time, regardless of the type of insurance Jayne’s job provides. If the household’s income is over 150% FPL, Jayne will need to see what percentage of the monthly premium her employer contributes. If the employer pays 80% or more of the monthly premium for the family, Suzie would have to meet a deductible to become eligible for BadgerCare Plus coverage. (She would become eligible for the Standard Plan, should she meet the deductible amount.) Alternatively, the family could look to the Katie Beckett Medicaid Program as a form of secondary coverage for Suzie. While this Medicaid program does not look at the household’s income level, it does look at the medical need and functional ability of the child. The family should review Suzie’s current level of care needs in addition to her therapy needs before making this decision.

Questions on this Answer?

Still not sure? Have another question? Send us an email! We may address emailed questions in the next edition of the Update Newsletter.

Events of Interest:

Finding Your Way: A Navigation Guide for Wisconsin Families Who Have Children and Youth with Special Health Care Needs and Disabilities has been published. Download a pdf version of the booklet here.

April 16. Parent to Parent of Wisconsin's Support Parent Trainings are held periodically throughout the State. Trainings are held in small group settings (8-15 participants). Registration is required for all trainings. The next training will be held on Saturday, April 16, 2012 from 9:00 am to 3:30 pm at the Children’s Hospital of Wisconsin Corporate Center (999 North 92nd, Milwaukee, WI). Call or email to register: 715-361-2934.

April 17, 5:00 - 8:30 pm, Door County (Brussels) - Family Voices Spring Training: “What’s After High School - Training on Transition” is training on transition to adult life for youth with disabilities and/or special health care needs. Topics include: envisioning a youth’s future in the community; the role of schools; long term supports; vocational resources; transitioning to adult health care; guardianship and other legal options; advocacy; and the fundamentals of self-determination. Contact the Northeast Regional Center at 877-568-5205 or email Kara at KVanVooren@chw.org.

WI Youth Leadership Forum is accepting applications for its 2012 Leadership Forum event. The YLF is a FREE program for high school students with disabilities who would like to take part in a unique and fun week long leadership development program. Participants will sharpen their leadership and self-advocacy skills, develop their career awareness, experience college life, meet successful speakers from across the state with similar disabilities as theirs and develop their own Personal Leadership Plan that they will implement when they return home. The YLF will be held June 17 – 22, 2012 on the Edgewood College campus in Madison, WI. The APPLICATION DEADLINE is April 16, 2012. The YLF is a competitive process. Applicants must complete the application, submit a brief response to 2 essay questions and obtain 3 letters of recommendation.

April 19. CYSHCN Collaborator's Meeting, Wisconsin Dells.

April 20-21. Youth in Partnership with Parents for Empowerment. 5 p.m. Fridays ending by 3 p.m. on Saturdays at the Tundra Lodge Resort & Conference Center, Green Bay, WI. Youth, parents and guardians must attend all five sessions. For more information, contact Martha DeYoung at 800-862-3725.

April 26-27. Circles of Life Conference 2012: a statewide conference for the families of children and youth with disabilities and the professionals who support them. This year's conference will be at the Madison Marriott Hotel. Fore more information, click here.

Is there an event missing from our list? Let us know! Email us with events, directions and details other collaborators may like to attend.

May 2, 5:00 - 8:30 pm, Eau Claire - Family Voices Spring Training: “What’s After High School - Training on Transition” is training on transition to adult life for youth with disabilities and/or special health care needs. Topics include: envisioning a youth’s future in the community; the role of schools; long term supports; vocational resources; transitioning to adult health care; guardianship and other legal options; advocacy; and the fundamentals of self-determination. Contact the Western Regional Center at 800-400-3678 or email Rose at rmarsh@co.chippewa.wi.us.

May 3, 10:00am - 1:00pm, Black River Falls. Family Voices Spring Training: “Did You Know? Now You Know” is a training that provides a comprehensive overview of health care, community supports and services and resources for children and youth with disabilities and special health care needs from birth through young adulthood. Contact the Jackson County Birth to 3 Program/Family Support Program at 715-284-4301 x 301 (Anita) or x 359 (Erin) or email Anita.Leis@co.jackson.wi.us.

A Training Announcement for All CYSHCN Collaborators: Thursday, May 17, 10:30-11:30am -- watch your inbox for login information!

Topic: "Transitioning to Adulthood, Part 2: A Closer Look at Coverage Options"

Thank you to everyone who tuned in for our last LIVE webcast featuring coverage transitions for children on SSI. As children become adults, their medical needs and coverage options may change at the same time. In May, we will continue our discussion of transitioning to adulthood, taking a closer look at health care coverage programs that terminate or have different rules when a child turns 19. Join us as we discuss "tips for planning ahead" for CYSHCN on BadgerCare Plus, Katie Beckett, and Private Insurance.

When you tune in live on May 17, keep in mind the following learning objectives:

Review the basics of Adult Disability Programs
Learn how to help families plan, obtain, and organize useful transitioning information
Recognize key dates and timelines for adult benefits programs
Use resources to facilitate a smooth transition from child- to adult- disability programs
Keep current on case management strategies that work for families.

Other Trainings: Trainings are the THIRD THURSDAY OF EACH MONTH, 10:30am!! Collaborators, stay tuned to the Update for information on the next training topic, which will include SSI-E! Past trainings are also archived for your convenience. If you have any questions, Email Adam!

Referrals to ABC: CYSHCN Collaborators, click the "Referral Form" image at right to be directed to the printable version of the CYSHCN Client Referral Form! Use this handy tool in directing a family to ABC for Health for services.

Why should you use this Referral Form? It helps keep YOU in the loop! By using the form, you agree to the language on the form that says you have "Verbal permission from parent/guardian to share information with ABC for Health." This allows us to communicate with YOU!

Headlines

Health Reform on the Brink: Uninsured in Missouri
PBS Newshour, Apr. 16, 2012
That's how much health insurance would now cost the five-member Hill family -- just shy of $100,000 per year.

Conservative Scholar: Supreme Court Should Uphold Obamacare
Huffington Post, Apr. 16, 2012
Yet another prominent conservative legal scholar has stepped forward to urge the Supreme Court to uphold health care reform as firmly within the court's precedents.

The Plot to Keep Health Care Prices From Consumers
The Fiscal Times, Apr. 16, 2012
Markets cannot work when consumers and patients have almost no information about the prices they pay for health care.

Critics say proposed rule would make millions ineligible for insurance subsidies
Kaiser Health News, Apr. 15, 2012
A proposed Treasury Department rule says workers and their families cannot qualify for those subsidies unless their employer's plan is unaffordable because it exceeds 9.5 percent of their household income.

Why Medical Bills Are a Mystery [Opinion]
The New York Times, Apr. 15, 2012
When insurance companies or government bodies try to control costs, they usually make across-the-board reimbursement cuts that ultimately are unsustainable because they have no connection to the true costs of delivering care.

Nursing homes say it's time for states to undo Medicaid cuts
The Hill, Apr. 13, 2012
States should boost their Medicaid spending as the economy improves and their budgets begin to grow back, the nursing home industry said Friday.

Nebraska Governor rejects Prenatal Care Funding For Illegal Immigrants
Reuters, Apr. 13, 2012
Nebraska Governor Dave Heineman vetoed a proposal to restore Medicaid-funded prenatal care for illegal immigrants on Friday, but the initiative could still survive if the state legislature rejects his move next week.

Impacts of Rising Health Care Costs on Families with Employment-Based Private Insurance
RAND Health, 2012
Rising health costs reduced employment-based insurance's availability, enrollment, and financial protection. The effects were significant for middle income families.

How Would Eliminating the Individual Mandate Affect Health Coverage and Premium Costs?
RAND Health, 2012
An analysis of the effects of implementing the Affordable Care Act without an individual mandate found that over 12 million people who would have otherwise signed up for coverage will be uninsured and premium prices will increase by 2.4 percent.

ACA Federal Funds Tracker
Kaiser Family Foundation, 2012
This online tool tracks funds received by the states, local governments, employers, community organizations, and other entities to implement provisions in the Affordable Care Act

Increased scrutiny of tax credits could mean more audits for Wisconsin's poor
Wiscosnin State Journal, Apr. 12, 2012
As Tax Day approaches, some low-income taxpayers in Wisconsin will notice smaller refunds — and increased scrutiny on claimed tax credits — because of changes in state law and a new effort by the Wisconsin Department of Revenue to ferret out fraud.

UnitedHealthcare launches bilingual mobile website
Journal Sentinel, Apr. 12, 2012
UnitedHealthcare has launched a bilingual mobile website aimed at Latinos that provides health and wellness information. The mobile website, which can be accessed by entering m.uhclatino.com on a smartphone browser, offers extensive information, tools and resources on health and wellness in English and Spanish, the company said.

If Obamacare Is Struck Down, These Americans Are in Trouble
Mother Jones, Apr. 12, 2012
Aside from banning discrimination against children on the basis of preexisting conditions, about 2.5 million young Americans have benefited from being able to stay on their parents' health insurance until age 26. Seniors no longer have to spend thousands of dollars out of pocket before qualifying for assistance paying for their prescription drugs. The Affordable Care Act has also eliminated the cap on lifetime benefits

Nancy-Care: Making Insurance More Affordable for Small Businesses
Healthcare.gov, Apr. 11, 2012
The small business tax credit provided by the Affordable Care Act was important to Nancy’s company. For 2010 and 2011, the credit helped with Glen Group’s bottom line

Insurance Company Ordered to Pay $34 Million For Kicking 90-Year-Old Arlene Hull Off Plan
Huffington Post, Apr. 11, 2012
Arlene Hull, a 90-year-old Montana woman, has won a lawsuit against an insurance company that refused to pay her nursing home bills and now must pony up millions.

If the Health Care Mandate Is Struck Down, Single-Payer Becomes the Best Choice
Huffington Post, Apr. 11, 2012
Ever since Republicans convinced the Obama administration to drop the "public option" in the Affordable Care Act, health reform has been in trouble.

Out-of-state Insurance Law Does Nothing Yet
Georgia Health News, Apr. 11, 2012
House Bill 47 would let health insurers in Georgia sell policies from states that have fewer coverage requirements. Proponents said these out-of-state policies, stripped of Georgia’s mandates, would have lower premiums – and allow more people to afford individual health insurance coverage. The high-profile legislation was passed by the Legislature last year and signed into law. But a year later, nothing has happened. No insurer here has started selling a non-Georgia health plan.

Misconceptions seen in health care reform arguments
Chicago Tribune, Apr. 10, 2012
During the recent oral arguments some of the justices and the lawyers appearing before them seemed to be under the impression that the law does not allow most consumers to buy low-cost, stripped-down insurance to satisfy its controversial coverage requirement. In fact, the law provides for a cheaper "bronze" plan that is broadly similar to today's so-called catastrophic coverage policies for individuals, several insurance experts said.

Supreme Court justices grapple with health care law’s minimum coverage mandate
Washington Post, Apr. 10, 2012
Excerpts from oral arguments before the Supreme Court on the health care overhaul law.

Johnson & Johnson Subsidiary Hid Risks Associated With Risperdal, Drug That Made Company Billions
Huffington Post, Apr. 10, 2012
Risperdal, introduced in 1994, is a "second-generation" antipsychotic drug that earned Johnson & Johnson billions of dollars in sales before generic versions became available years ago. It is used to treat schizophrenia, bipolar disorder and irritability in autism patients. Risperdal and similar antipsychotic drugs have been linked to increased risk of strokes and death in elderly dementia patients, seizures, weight gain and diabetes.

Utah Breach Affects 25,000 Social Security Numbers
MSNBC, Apr. 9, 2012
Utah health officials said Friday that hackers who broke into state computers last weekend stole far more medical records than originally thought, and the data likely includes Social Security numbers of children who have received public assistance.

New health care law provisions cut red tape, save up to $4.6 billion
HHS, Apr. 9, 2012
The proposed changes would save health care providers and health plans up to $4.6 billion over the next ten years, according to estimates released by the HHS today. The estimates were included in a proposed rule that cuts red tape and simplifies administrative processes for doctors, hospitals and health insurance plans.

Say What? Most Insurance Covers Little of the Cost of Hearing Aids
Kaiser Health News, Apr. 9, 2012
Only a quarter of the 35 million U.S. adults who could benefit from hearing aids actually get them, and one of the main reasons is money. A hearing aid typically costs a few thousand dollars, sometimes much more, and most insurance plans don’t cover that.

Heavy Burden
The New Yorker, Apr. 9, 2012
The decision is a great deal more important than its immediate political aftermath. It’s about what the government can do, not just who runs it. If the Court acts in line with the sentiments expressed by the conservatives last week, it could curtail the policymaking options of Congress for a generation. It is simply not the Supreme Court’s business to be making these kinds of judgments

Supreme Court Recap: How the Oral Arguments Got Medicaid Wrong
National Health Law Program, Apr. 9, 2012
Five misstatements made during the oral argument are addressed in this newsletter.

Obama administration diverts $500 million to IRS to implement healthcare reform law
The Hill, Apr. 9, 2012
The money is only part of the IRS’s total implementation spending, and it is being provided outside the normal appropriations process. The tax agency is responsible for several key provisions of the new law, including the unpopular individual mandate.

Public Reporting Of Health Care Quality: Principles For Moving Forward
Health Affairs, Apr. 9, 2012
If we extrapolate too much from studies that are based on flawed measures deployed in flawed settings, we won’t get much insight on how to create a flow of information that provides value to the health care system we’re trying to encourage.

The Demographics of Health Care
Ad Age, Apr. 9, 2012
How Do Consumers Budget for Its Costs, and How Do They React When They Get Sick?

Dental Insurance, but No Dentists [Opinion]
The New York Times, Apr. 8, 2012
"Under the Affordable Care Act, 5.3 million more children will be entitled to dental benefits from Medicaid and the Children’s Health Insurance Program. Little is being done — by the dental profession or by the federal or state governments — to prepare for it."

Walker signs slew of controversial legislation, including anti-abortion and sex ed bills
The Chippewa Herald, Apr. 7, 2012
Gov. Scott Walker quietly signed a set of contentious GOP bills barring abortion coverage through health insurance exchanges, requiring doctors to consult privately with women seeking abortions and mandating sex education teachers stress abstinence.

Patients urged to ask about cost of health care
AZCentral, Apr. 7, 2012
To encourage people to take greater responsibility for their health-care spending, health-insurance companies and the federal government are providing online tools to help educate consumers.

Walker signs bevy of bills into law
Journal Sentinel, Apr. 6, 2012
Gov. Scott Walker has signed bills putting new restrictions on abortion, requiring schools that teach sex education to promote marriage and barring those who are discriminated against at work from suing for punitive damages in state court.

Feds approve plan to restore kids' health coverage
AZCentral, Apr. 6, 2012
Arizona will add nearly 22,000 low-income children to its health-insurance program under a deal that won federal approval Friday. The deal also will provide three large hospital groups with federal funding to care for uninsured patients.

Planned Parenthood of Wisconsin Supports National Campaign Encouraging Young People to “GYT” During STD Awareness Month
Press Release, Apr. 5, 2012
The fourth annual GYT: Get Yourself Tested campaign kicks off National STD Awareness Month (April) with new initiatives on-air, online, and on the ground at college campuses and in more than 5,000 health centers across the nation.

Prenatal care proposal for illegal immigrants divides Nebraska lawmakers, frustrates governor
Washington Post, Apr. 5, 2012
The issues of illegal immigration and abortion have split Nebraska’s Republican-dominated politics, with some conservatives supporting a plan to offer state aid to pregnant women in the country illegally and others arguing that doing so would violate a bedrock GOP belief.

Man admits setting fire at Planned Parenthood Clinic
Associated Press, Apr. 4, 2012
A Wisconsin man tells a judge he wants to plead guilty to the arson fire that damaged a Planned Parenthood clinic.

April 16 National Healthcare Decisions Day brings home advance planning; client guide gives lawyers a tool for discussions
State Bar of Wisconsin, Apr. 4, 2012
In recognition of NHDD, the State Bar is offering free electronic access to its consumer guide, A Gift to Your Family: Planning Ahead for Future Health Needs.

Drug Spending Levels Off, But Not For The Usual Reasons
NPR, Apr. 4, 2012
Normally, a slowdown in spending is because the drug industry hasn't produced many breakthrough medications — with their hefty price tags. But that wasn't the case this time around. Last year saw "the introduction of the most new medicines in a decade," according to the report, including "breakthrough therapies ... to treat several types of cancer, multiple sclerosis, hepatitis C and cardiovascular conditions."

Americans Cutting Back on Drugs and Doctor Visits
The New York Times, Apr. 4, 2012
Patients cut back on prescription drugs and doctor visits last year, a sign that many Americans are still struggling to pay for health care, according to a study released Wednesday by a health industry research group.

Physicians Wade Into Efforts To Curb Unnecessary Treatments
Kaiser Health News, Apr. 4, 2012
The campaign comes amid a variety of efforts – some called for in the federal health law – to compare the effectiveness of treatments and to change payment incentives to doctors and hospitals to reward quality and penalize inefficiency

HealthCare Social Media Review
HealthWorks Collective, Apr. 4, 2012
Aggregated articles on uses and debates over social media and healthcare.

Health care law expands support for children and families
HHS, Apr. 3, 2012
To improve the health and development of children, 10 states received grants to provide early childhood supports and home visits to families who volunteer to receive these services. These awards are part of the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) created by the Affordable Care Act. The nearly $72 million in funding announced today will allow states to expand or establish their home visiting program.

Dentists will share Wisconsin SBA award
Wisconsin State Journal, Apr. 3, 2012
Four dentists will share the 2012 Wisconsin Small Business Person of the Year award issued by the U.S. Small Business Administration.

Insurers Push Back On Consumer Rebate Letter
Kaiser Health News, Mar. 29, 2012
The industry and the Obama administration are at odds over proposed language in the letter that goes with the checks as well as who gets notification. The administration may require insurers to send notices about rebate rules even to customers who aren’t getting a rebate.

The Real Cost of Healthcare
RAND Health, Mar. 29, 2012
Only by confronting the brutal facts — but never losing faith — can we hope to improve America's costly and underperforming healthcare system into the high-value system Americans need and deserve.

Wisconsin Watches Nervously as Court Hears Health Care Case
Huffington Post, Mar. 28, 2012
Any court decision that effectively rolls back or repeals the Affordable Care Act (ACA) would be a double-whammy for Wisconsin health care consumers. Not only would everyone who is helped by the law lose their hard earned benefits, many would also still be left to rely on a safety net that Gov. Scott Walker is relentlessly tearing down.

The Elephant in the Courtroom
The New Yorker, Mar. 6, 2012
Amid grim tidings, there remains for conservatives a reliable source of good news: the Supreme Court.

Local Data on Poverty and Health Insurance Coverage in Wisconsin
DHS, Feb. 21, 2012
This page provides access to local information about poverty status and health insurance coverage for many localities in Wisconsin. Estimates of the number and percent of the population by poverty status, health insurance coverage over the past year, and type of health insurance are based on combined years of Wisconsin Family Health Survey results.

How Would Eliminating the Individual Mandate Affect Health Coverage and Premium Costs?
RAND Health, Feb. 16, 2012
As the individual mandate provision of the Patient Protection and Affordable Care Act of 2010 (ACA) is reviewed by the Supreme Court, researchers at the RAND Corporation have estimated how repealing the mandate would affect the number of adults insured, the cost of insurance premiums, and government spending.

Seeking Legal Interns for Summer 2012

ABC for Health is seeking volunteer, work-study eligible, or students on public interest fellowships for this summer! The position requires admission to law school. Students will provide legal research and writing support for firm attorneys that may include client interviewing and follow-up, drafting letters and memos, assisting on court filings and briefs, and facilitating projects with other agencies and legislators. Other duties include interviewing clients at intake, client counseling, and investigation of health benefits denials. Legal research and writing experience are desired, as are proficiency in Microsoft Word for Windows and a background in health care. Ability to speak Spanish and/or Hmong is a plus. To apply, please email a cover letter and resume to Brynne McBride, Assistant Director.

Support Our Efforts!

2011 was a difficult year for many, including ABC for Health. Over $300,000 in funding and funding opportunities were eliminated from our budget. Consequently, our ability to serve Wisconsin families was greatly diminished. Please consider a tax-deductible donation to ABC for Health to keep advocacy, legal services, and projects like HealthWatch Wisconsin sustainable for years to come. Thank you!

HealthWatch Wisconsin is a project of ABC for Health, Inc.
Update Staff:
Bobby Peterson, Executive Director
Brynne McBride, Assistant Director
Adam VanSpankeren, Education and Outreach Coordinator
Evan Benner, Publications Assistant

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