HealthWatch Events Fill the Summer!

The Immigrant Health Coverage training kicks off a summer full of events! Tune in for the live webcast next week and then mark your calendar as HealthWatch today announces the BadgerCare+ Express schedule for the trip across Wisconsin! Read more below.

The Immigrant Health Coverage Live Webcast Training is in 6 Days!!

There is Still Time To Register -CLICK HERE!

Learn about the health care coverage options available to non-qualified immigrants in Wisconsin. The webcast will air LIVE on July 21 at 9:30 a.m., and viewers will be able to submit questions as it plays.

REGISTER ONLINE or CALL: 1-800-585-4222 ext. 204

This training is FREE for 2011-2012 HealthWatch Wisconsin members ($50 for non-members). Not available to watch on July 21? Don't worry! The webcast will be available on-demand to HWW members in the HealthWatch Wisconsin Training Portal.

Memberships are Rolling In--It's Not Too Late To Join!

A New HealthWatch Year Began July 1!

It's Not Too Late To Join HealthWatch Wisconsin Today! HealthWatch Wisconsin is your source of accurate and timely information to help Wisconsin families and patients seeking care and coverage. You and your organization need to BE INFORMED to help families and patients. A New Membership Year Starts TODAY!

JOIN TODAY! You can join or renew using the method that works best for you:

• CALL US: Call Adam at 1-800-585-4222 ext. 204.
• ONLINE: Join or renew online.
• EMAIL US: Send a simple email to Adam.
• INVOICE: Request an invoice!  Please contact Adam and tell him the best address to email, mail or fax your invoice (Call: 1-800-585-4222 ext. 204 or email).
• FACEBOOK: Join HealthWatch on Facebook!

Questions? Call HealthWatch Wisconsin staff for more information at 1-800-585-4222 ext. 204.

Stay tuned for Green Bay Packer Ticket Prize Drawing news!  Your chance to win as a HealthWatch member is coming soon!!

Vol. 7, No. 13
July 15, 2011

In this issue:

Immigrant Health Coverage Issues Training-Register Today!

Join or Renew with HealthWatch Today!

BadgerCare+ Express Schedule

Premium Hike for BC+ Basic

DHS Secretary Smith's "Good" 180 on Public Health Funding

Commissioner of Insurance's "Bad" 180 on Consumer Assistance

Case Tip: Dependent Coverage

Grapevine: LogistiCare Could Be A Real Problem

HWW Public Hearings

Member Profile

Coalition Roundup

CKSN Corner

Ops Memos

State & National News

On our website:
HealthWatch Membership
Upcoming Coalition Meetings

HealthWatch News

The BadgerCare+ Express Schedule

HealthWatch Wisconsin's BadgerCare+ Express hits the road next month! A series of coordinated workshops and exhibits will feature HealthWatch Wisconsin staff, members and community leaders to talk about BadgerCare Plus retention! Many consumers and service providers know how to "Get BadgerCare Plus," but how many know how to "Keep BadgerCare Plus?!" Workshops will also discuss enrollment basics and the legal and administrative hurdles that families encounter with BadgerCare+ health coverage programs.

HealthWatch will make five BadgerCare+ Express stops across Wisconsin, meeting with families and professionals, providing consumer assistance, and most importantly, conducting education on BadgerCare+ programs, complete with printed 3 Steps to Family Health Coverage kits. A printed version of the AdvoKit will also be made available to HealthWatch Wisconsin members.

Many stops have been confirmed - please see the dates below for the stop closest to you!

• Milwaukee: August 2 - Save the Date!
• Eau Claire: August 9
• Ashland: August 10
• Green Bay: TBD
• Madison: TBD

Stay tuned as the dates and locations of the final stops are confirmed! The first stop is in Milwaukee and is co-sponsored by the Milwaukee HealthWatch Coalition. Click here to see the Save the Date card! For information on any of the stops, please contact HealthWatch staff. Please RSVP to Adam if you are interested in attending a BadgerCare+ Express training event!

Premium Hike for BadgerCare Plus Basic Plan

Wisconsin's Department of Health Services announced in an Operations Memo dated July 15 that premiums for the BadgerCare Plus Basic Plan would once again be increasing, this time to $250 per month. The first premium payment reflecting the increase will be due August 5, 2011 for September coverage.

DHS is relying on the language in a Wisconsin Statute to justify the increase, saying that the revenue collected through premium payments is not sufficient to cover the cost of the program. Recall, premiums for Basic were increased from $130 to $200, with the first $200 premium payment due May 5, 2011 for June coverage. (Note, this July 15 operations memo incorrectly stated that the May premium was for “July” coverage instead of June coverage.)

The premium increases may help explain the drop of approximately 950 individuals from April through June (the most recent data available from DHS). An individual on the BadgerCare Plus Basic Plan with an income at 100% FPL will easily be paying 27.5% of his annual income in Basic Plan premiums.

The increased premium will be reflected on the premium payment slip sent in July. Members who made advanced payments will not be required to pay an increased amount until the months for which they have prepaid have ended. To see a sample of the notice Basic members will receive in the US Mail announcing the premium change, see pages 3 & 4 of the attachment.

DHS Secretary Smith's "Good" 180 on Public Health Funding

After intense pressure on the Department of Health Services, Secretary Dennis Smith has changed his mind, and will now support the City of Milwaukee and other applicants as they apply for over $30 million in public health federal grants. The prevention grants were initially deemed "duplicative" and a "waste of taxpayer money." Sound familiar? See "Commissioner of Insurance's 'Bad' 180" below. The grant proposals are targeting smoking and obesity while promoting healthier lifestyles.

• Welcome state health secretary's turn-around on public health grants
• State reverses course, supports city's bid for federal health grants
• Urge feds to consider health grant applications without Gov. Walker's support

DHS Budget Summary

On July 8, 2011, Wisconsin's Department of Health Services posted a summary of the "Major Provisions for DHS" in the state's new biennial budget in the form of a PowerPoint presentation.  The slides begin with an overview of the budget process, from submission of the agency's request through the Governor's partial vetos and signature. The following sampling of slides provides an overview of the major policy provisions addressed in the budget while giving a sense of the justifications accompanying the changes:

• Slide 5: Authority granted to DHS to reform Medicaid and BadgerCare Plus (called "implementing efficiencies" on the slide)
• Slide 5: Eliminate maintenance of effort requirements:
  • DHS is to request a waiver of maintenance of effort requirements.
  • "If waiver is not granted by January 1, 2012, DHS must 'comply' with federal requirements under ACA and instead end enrollment for non-disabled, non pregnant adults above 133% of the federal poverty level."
• Slide 13: Reform Income Maintenance
  • Counties will form up to 10 consortia
  • Counties will contribute county funds to consortia at least CY 09 levels.
  • DHS will issue contracts based on caseload
  • DHS will operate a statewide document processing center
• Slide 16: End Family Planning Only Services for Men
  • Directs DHS to apply for federal waiver to continue coverage for women.

Stay tuned for future editions of the HealthWatch Update and HealthWatch Reporter where the DHS PowerPoint presentation will be broken down and discussed in more detail.

Commissioner of Insurance's "Bad" 180 on Consumer Assistance

On July 14, Public Interest Law Firm ABC for Health, Inc. (ABC) filed a supporting brief related to a claim for $176,250 plus expenses against the Wisconsin Commissioner of Insurance Ted Nickel. The claim arises from the termination of the Consumer Assistance Grant contract between the Commissioner of Insurance (OCI) and ABC. Also mentioned in the claim filed with the State Claims Board, are Deputy Commissioner of Insurance Dan Schwartzer, Department of Health Services Secretary Dennis Smith, Deputy Secretary Kitty Rhoades, and Governor Walker’s Deputy Chief of Staff Eric Schutt.

The brief claims that newly appointed Commissioner Ted Nickel and his Deputy Dan Schwartzer’s decision to terminate a carefully crafted and unduplicated consumer assistance program that included ABC was unlawful and inequitable. Bobby Peterson, Public Interest Lawyer at ABC, said, “Commissioner Nickel thoughtlessly terminated a promising program to help consumers navigate the maze of health insurance. In January 2011, OCI recklessly pivoted 180 degrees and shunned opportunities to support consumer assistance and instead pandered to the insurance industry and a mean spirited political ideology that is out of step with the people of Wisconsin.”

Read the full press release here.

Read the brief and attached exhibits online.

Case Tip

Dependent Coverage in Wisconsin: 26 or 27?

Even as the Affordable Care Act was being unveiled, Wisconsin was ahead of the curve in terms of dependent coverage, allowing adult children on health plans governed by state law to remain on their parents' health insurance up to age 27. Recently, a bill was circulated in the Wisconsin legislature to repeal dependent coverage and adopt, instead, federal law to exclude from an employee’s income payments certain payments from an employer related to medical care. Essentially, the bill would scale back the insurance mandate and permit dependent coverage only to age 26. At the same time, language was inserted into the state budget bill (tucked into the General Fund Tax Omnibus) to do the same. The budget bill was signed by Governor Walker on June 26, and so the rollback of dependent coverage became law. Please note: while the budget changed the rule on dependent coverage, this particular change will not be effective until January 1, 2012.

Grapevine

LogistiCare Could Be A Real Problem

Reports are still coming in that LogistiCare's administration of non-emergency medical transportation in Wisconsin is having a serious issues. In just two weeks since the start of its contracted services, HealthWatch has heard reports of people being denied rides to appointments that should be covered, kids not being able to go with their parents to appointments, and urgent care appointments being mishandled. As stories continue to pour in, HealthWatch Wisconsin will be tracking this important issue.

If you've been personally affected by dealings with LogistiCare and would like to share your story, positive or negative, please contact HealthWatch staff.

For more information on LogistiCare and the status of their contract, be sure to check out Shawn Doherty's July 10 Vital Signs Blog and July 6 Vital Signs Blog.

HealthWatch Public Hearings: The Human Impact of Medicaid/BadgerCare Cuts in Wisconsin

HealthWatch Wisconsin has posted the complete video footage of public testimony on the impact of proposed BadgerCare+ and Medicaid cuts that will affect 1.2 million Wisconsinites covered by these programs. In March, HealthWatch Wisconsin sponsored two days of public hearings during the HealthWatch Wisconsin Annual Conference, drawing hundreds of people to listen, learn, and for some, to share their stories and the stories of loved ones. HealthWatch Wisconsin staff was on hand to record participants' testimony.

View the public testimony footage online.

Member Profile

Jon Peacock, Wisconsin Council on Children and Families
By Katie Foran-McHale

Jon Peacock serves as the Research Director for the Wisconsin Council on Children & Families. The WCCF focuses on an intersection of health and fiscal policy, providing timely, credible and reliable analysis. “We work on providing information that reporters and policymakers will be able to trust,” he said.

Jon keeps track of state legislation, approaching analysis from the perspective of how the issues affect low-income families. “We don’t have all the answers, but we potentially have more knowledge about the state’s fiscal challenges and opportunities, and we try to share that with other advocates and nonprofits to enable them to do their legislative advocacy more effectively,” he said.

Like many health care advocates, Jon is concerned about threats to Medicaid programs that were passed in the state budget July 1. These threats include significantly increasing premiums that may lead families to drop out of the program; changing crowd-out policies that will disallow enrollment if an applicant has any access to private insurance, regardless of whether he or she can afford it; more frequent reviews and verifications for eligibility; and a reduction of eligibility for adults to 133% FPL, which cuts 63,000 people from receiving Medicaid.

“Policymakers are placing a much lower priority than we do on protecting programs for low-income families,” he said. “It’s a very challenging time to be convincing policymakers that we need to maintain Wisconsin’s long tradition of serving disadvantaged families.”

Jon thinks balancing the budget shouldn’t come exclusively from cuts—that the legislature could use different combinations of approaches, including taxing the rich. “We need reforms that make the system more efficient, not ones that shift costs and leave more people uninsured,” he said.

Having been a HWW member since its inception and a member of the HWW Council for three years, Jon joined for the potential of expertise from a broad range of providers, advocates and others in the health care system who see what’s going on in the front lines. He is also collaborating with HWW to document detailed stories of families whose lives are greatly affected by BadgerCare or a lack of insurance.

“Story banking puts a human face on the more abstract arguments that we make,” he said. “For instance, a lot of legislators who have government insurance and comfortable incomes have no idea how difficult it is for low income families to come up with what may sound like a modest amount for premiums.“

He also wants to work with HWW to help identify barriers to enrolling, renewing and accessing health services that people need.

In today’s climate, Jon thinks the public realizes that although the state government said they could reduce spending without harming important public services, this isn’t the case. “I’m very frustrated that the state appears to be moving backwards and reversing the progress that we’ve made in improving access to coverage, but I’m also guardedly optimistic that most of the public is still on our side,” he said. “We can win on these issues if we can get everything onto the table, if we can avoid the budget decisions being made in a way in which caps are put on spending and boxes are created that tie the hands of policymakers…Conservative lawmakers want to change the rules of the game and make it impossible to balance spending and taxes at the same time.”

Coalition Roundup

Click here for a list of upcoming coalition meetings.

The Dane County HealthWatch Coalition took July off. However, the Dane County HealthWatch Steering Committee invites members to join them in seeing the Dirty Shirts at the High Noon Saloon in Madison on Tuesday, July 19th at 6:30pm. It's an opportunity for coalition members to further connect and reflect on a long, engaging year, full of changes and challenges. The Dane County HealthWatch Coalition will meet formally again on August 1. For more information about the Dane County HealthWatch Coalition, please contact Adam VanSpankeren.

The Milwaukee HealthWatch Coalition met Wednesday, July 13, to welcome Josh Weisbrod of the Health Insurance Risk-Sharing Plan (HIRSP) Authority. Mr. Weisbrod went into detail on the differences between the state and federal HIRSP options and fielded questions from the group. HIRSP offers health insurance to Wisconsin residents who either are unable to find adequate health insurance coverage in the private market due to their medical conditions or who have lost their employer-sponsored group health insurance. The Milwaukee HealthWatch Coalition meets on the second Wednesday of each month from 9:30-11:30am at Aurora Family Service (3200 W. Highland Blvd.; Milwaukee, WI 53208). For more information about the Milwaukee HealthWatch Coalition, please contact Nora Foshager.

The Pierce County HealthWatch Coalition will meet on the 3rd Thursday of September, January, and May, with September's speaker already confirmed: Jena Most from the Reproductive Health Division of the Pierce County Health Department to discuss Family Planning Other Services and the Wisconsin Well Woman Program For more information about the Pierce County HealthWatch Coalition, please contact Lisa Raethke.

Both the Polk and Barron County HealthWatch Coalitions are taking a break for the summer, but coalition coordinator Mike Rust of ABC for Rural Health is very active in planning the BadgerCare+ Express stop to the northwest region of the state and has been speaking at other coalitions, as well, updating them on the budget and the ever-changing public health landscape.  To learn more about either of these two coalitions, please contact Mike Rust.

The Tri-County HealthWatch Coalition met June 28 at the Goodwill Community Center, 1800 Appleton Rd. in Menasha to follow up on their strategic plans, including the development of three subcommittees: data collection, advocacy, and mental health. The coalition reviewed the budget and all of its unspecified cuts to Medicaid and also let everyone know about the new HealthWatch Wisconsin membership year. The next Tri County HealthWatch meeting will be on July 26, from 9:00-11:00am. For more information about the Tri-County HealthWatch Coalition, contact Susan Garcia Franz or Connie Raether.

CKSN Corner

Covering Kids with Special Needs

Wisconsin's CYSHCN Program is made up of a significant network of collaborators who work together to ensure access to care and coverage for children and youth with special health care needs.

The National Youth Leadership Network announces their new curriculum: Reap What You Sow: Harvesting Support Systems Curriculum Training Packages. Reap What You Sow brings youth and adults together to build support systems. For more information, click here.

July 25-27. Leadership, Legacy, and Community: A Retreat to Advance Maternal and Child Health (MCH) Scholarship and Practice. Hyatt McDonald's Lodge, Oak Brook, IL. Learn more information here, or register here.

September 21. Making Connections: Care in the Community Conference. Radisson Hotel, Wauwatosa, WI. Topics will include advocacy, mental health, transition and a health benefits update. For more information, visit maxishare.com.

September 22. Did you know? Now you know! Aging and Disability Resource Center of Manitowoc County, Manitowoc, WI. 5:30-8:30 p.m. Topic: Parents and partners on a journey; public support systems available to assist you and your child; private insurance and your provider. To register, call 877-568-5205 or email KVanVooren@chw.org.

October 1. Did you know? Now you know! Aging and Disability Resource Center of Manitowoc County, Manitowoc, WI. 9 a.m.-noon. Topic: More about Medicaid; advocating for systems change. To register, call 877-568-5205 or email KVanVooren@chw.org.

Ops Memos

On July 1, DHS issued an Operations Memo 11-35, effective July 1, 2011, instructing that Tribal members and close family relatives are EXEMPT from paying application processing fees and premiums. (See Table 51.1 in the BadgerCare+ Eligibility Handbook to see which recipients are receiving Medicaid-funded benefits.) This applies to:

1. Individuals receiving Title 19-funded BadgerCare Plus if they are a Tribal member, the son or daughter of a Tribal member, the grandson or granddaughter of a Tribal member, or they are otherwise eligible to receive Indian Health Services
2. Children who are Tribal members or who are the son or daughter of a Tribal member and eligible for Title 21-funded (separate CHIP program) BadgerCare Plus. (Previously, only children who were tribal members were exempt from premium payments.)
3. Anyone meeting the Medicaid definition of ‘Indian’ is also exempt from paying the processing fee for a Core Plan application or renewal.
4. These Title 19 premium exemptions do not apply to Medical Assistance Purchase Plan (MAPP) premiums, cost share amounts for Long Term Care Medicaid and patient liability for Institutional Medicaid.

Retroactive: Members who paid premiums between July 2009 and August 2011, who should have been exempt as a Tribal member, or son or daughter of a Tribal member, will be identified through a central process and the premiums will be refunded. The member must have verified that he or she is a Tribal member or son or daughter of a Tribal member to be considered exempt.

State & National News

Analysis and Comment

Building (and Governing) the Insurance Exchange

On Monday, July 11, Department of Health and Human Services Secretary Kathleen Sebelius announced the long anticipated proposed regulations governing how states should set up and run the health insurance exchanges envisioned in the Affordable Care Act. Wisconsin's Department of Health Services issued their own notice--a call for vendors to build Wisconsin's exchange, signaling that the state may abandon the progress made before the changing of administration.

Background

The Affordable Care Act, (health reform) requires states to set up their own health insurance exchange or "marketplace" by 2014. Exchanges are new organizations or agencies that offer consumers "one stop shopping" for a variety of health insurance plans for individuals insurance marketplace consumers, small businesses and public benefits--potentially Medicaid, BadgerCare Plus, FoodShare and Wisconsin Shares in Wisconsin.

• Offering a choice of health plans,
• Establishing common rules regarding the offer and pricing of insurance, and
• Providing information to help consumers better understand their options.

New Rules

On July 11, 2011, the U.S. Department of Health and Human Services (HHS) published two Notices of Proposed Rulemaking related to health insurance exchanges giving guidance to the states on what benchmarks they need to reach for their exchanges. The first proposed rule outlines how states can build insurance exchanges, while the second addresses standards related to reinsurance, risk corridors, and risk adjustment to assure stability in these newly established markets.

HHS published the proposed rule in the Federal Register on July 15 and will accept public comments for the next 75 days. HHS will also convene a series of "regional listening sessions and meetings" on the proposal to get additional public feedback.

Calling All Exchange Builders

Released July 8, 2011, the Office of Free Market Health Care issued a "Request for Information," to all "interested parties to demonstrate their product offerings." The Office is interested in learning "more about health insurance exchange systems and applications that serve the non-group and group health insurance markets." The demonstrations of products will take place August 1 & 2, 2011, and only those products with fully functional enrollment and plan comparison features need apply. Not required, but encouraged is functionality that shows health insurance education tools as they relate to purchasing health insurance and customer support--the "consumer assistance" pieces to the exchange. The same consumer assistance elements that Commissioner of Insurance Ted Nickel defunded on March 12, 2011. Curious whether the exchange built in autumn 2010 under the Doyle administration and debuted at the HealthWatch Wisconsin "The Changing Landscape" Health Reform Conference on October 28, 2010 will be among those demonstrated.

Headlines

Walker administration reverses course, now backs health grants
David Wahlberg, Wisconsin State Journal, 14 July
"Public health advocates seeking federal grants to prevent chronic diseases now have the state’s support, after Gov. Scott Walker’s administration reversed its opposition to the grants."

37 Democrats urge feds to deny Gov. Walker's Family Care freeze
Rep. Richards to HHS Secretary Sebelius, 14 July
"Family Care empowers some of Wisconsin's most vulnerable residents, and their families, by giving them choices about the services they need to remain independent and maintain a high quality of life."

AARP: Fewer plans will make exchanges easier to use
Sam Baker, The Hill, 14 July
"A new AARP report on state insurance exchanges says consumers will have an easier time comparing health plans if they're not presented with too many options. AARP analyzed several existing Web portals for insurance to help states figure out the most effective designs for their exchanges' websites. The exchanges are envisioned as one-stop shops for individuals and small businesses to compare and purchase insurance policies."

Health Care Spending and Quality in Year 1 Of The Alternative Quality Contract
Zirui Song, et al, New England Journal of Medicine, 13 July
"Family Care empowers some of Wisconsin's most vulnerable residents, and their families, by giving them choices about the services they need to remain independent and maintain a high quality of life."

Welcome state health secretary's turn-around on public health grants
Representative Jon Richards, Representative Sandy Pasch, 13 July
“'While I wish he would have supported these applications from the start, I am pleased our state’s top health officer finally saw the light on the benefits of investing in public health,' said Rep. Richards. 'Now Wisconsin can be considered for federal funding that will help address our state’s childhood obesity epidemic, reduce chronic diseases such as asthma and diabetes and lower overall health care costs.'”

State reverses course, supports city's bid for federal health grants
Guy Boulton, Milwaukee Journal Sentinel, 13 July
"Reversing its position, the state Department of Health Services has cleared the way for the City of Milwaukee and others to apply for federal grants totaling roughly $30 million over five years for public health initiatives to stop smoking, reduce obesity and promote healthier lifestyles."

Report: System to catch Medicaid fraud inadequate
Associated Press, 12 July
"The Government Accountability Office report said the systems don't even include Medicaid data. Furthermore, 639 analysts were supposed to have been trained to use the system - yet only 41 have been so far, it said."

Officials say the exchange rule includes flexibility for states
Kaiser Health News, 11 July
"Insurers want states to be granted great flexibility in how they design their exchanges – and don't want to be barred from seats on oversight boards. Consumer groups, however, would prefer that insurers not be allowed on the boards or, if they are, to meet strict conflict-of-interest rules."

Vital Signs: LogistiCare official answers critics
Shawn Doherty, The Cap Times, 10 July
"Badger Cab walked away from the contract after just one day on the job, fearing the chaos it says ensued would cause it to lose other customers."

Urge feds to consider health grant applications without Gov. Walker's support
Representative Jon Richards, Representative Sandy Pasch, 1 July
"Please consider Community Transformation Grant applications originating from Wisconsin without support from Governor Walker, whose opposition to these grants appears to be driven more by ideology than facts."

Click here for more health care news!

Copyright © 2011 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, Assistant Director
Adam VanSpankeren, Education and Outreach Coordinator
Katie Foran-McHale, Publications Assistant