ABC for Health provides hands-on technical assistance through Health Benefits Counseling to help un- and under-insured patients link to health care coverage resources at SSM-Wisconsin Hospitals, UnityPoint Health-Meriter Hospital, Sauk Prairie Hospital. Even expert provider staff are not likely to have the time to keep up with many complicated benefit programs and rules. Yet, time is of the essence for patients to gain eligibility for complicated and nuanced programs. Proactive Health Benefits Counseling is a winning formula to maximize third party reimbursements while serving the needs of patients. ABC's formula yields a general rate of return of 15:1.
With funding from the Wisconsin Trust Account Fund, ABC for Health provides direct legal representation and advice to low-income families facing denials of health care coverage and services. ABC is often the only source of legal assistance available for families encountering obstacles as they seek necessary health care services and coverage, or attempt to exercise their legal rights within the health care system.
ABC for Health partnered with other advocates to address knowledge and program barriers and promote education and outreach for stakeholders including families, providers, and advocates. We formed the HealthCheck Task Force (HCTF) to help promote and provide HealthCheck education and advocacy. Read more about the task force.
For many years ABC for Health has researched and examined the Medicaid related policy of Birth Cost Recovery in Wisconsin and the impact upon unmarried pregnant women and their families. ABC for Health remains concerned that the policy harms efforts to reduce infant mortality, lift families out of poverty and encourage unmarried fathers to play an important, supportive role in their children’s lives. Birth Cost Recovery (BCR) is a practice allowed, but not required, under title IV-D of the federal Social Security Act that allows states to pursue the recovery of Medicaid supported birthing costs from non-custodial fathers. Nearly 90% of all states have abandoned Birth Cost Recovery, some concluding that the policy is not in the best interest of infants, parents and families. Infamously, Wisconsin leads a small handful of states that continues to pursue this policy, and takes the most aggressive enforcement posture in the nation, collecting over $16 million from some parents in 2016. Unlike child support, none of the recovered dollars go to support the children and families – it is all directed to reimburse/incentivize child support offices or the government at the federal and state level. In 2019, ABC received a grant from the Office of Minority Health to help support our efforts. Read more.
Since our founding in 1994, ABC for Health Inc. has steadfastly maintained that access to health care coverage and care is a fundamental right of all people. Yet, our state and country struggles toward a goal and an ideal that remains elusive from both a policy and political perspective-coverage for all! And this Sisyphean task, that includes successes and setbacks, compels us to continue to share our ideas, experiances and concepts to further the debate to a just and equitable conclusion.
Building from earlier proposals, in 2019 we proposed the WisCare Plan in response to the people we speak with daily from across Wisconsin who need appropriate health care coverage. Our perspective, embodied in our WisCare Plan, reflects the knowledge and insights gained over 25 years of service to more than 60,000 adults and children from across the Badger state. Grounded in a common sense approach, WisCare responds to the needs of individuals and families as well as businesses that are committed to providing comprehensive health benefits to employees. Our WisCare Plan involves all key stakeholders and promotes neither a government takeover nor an increasingly privatized system. Read the proposal.
Today technology solutions that enhance patient advocacy strategies through promotion of access to health care and coverage offer a promising path forward. Precision Patient Advocacy™, an emerging patient interview, engagement, and advocacy strategy developed by ABC for Health Inc. and My Coverage Plan Inc., offers opportunities to promote health equity through improved access to health coverage and care for disparity patients. Similar to the emergence of Precision Medicine, Precision Patient Advocacy offers exciting possibilities through the use of carefully collected data. The comparison to the Precision Medicine initiative— that in part applies the use of genetic information to provide precise treatment services for patients—is intentional and by analogy.
Precision Patient Advocacy applies a myriad of unique health coverage eligibility markers such as: age, income, immigration status, medical status and employment, among others. Technology solutions offer the potential to promote improved alignment of variables unique to each person, then generate optimized health coverage opportunities. With an emphasis on assistance for disparity patients, My Coverage Plan, Inc. created and patented Advocus™, a software product to align, optimize, and record varied health care coverage information as a strategy to help prevent medical debt and uncompensated care. Read the whitepaper.
ABC provides enhanced training, networking, referral, and direct service project for Children and Youth with Special Health Care Needs (CYSHCN). ABC for Health’s attorneys and advocates work with statewide CYSHCN collaborators, Regional Centers for CYSHCN, and other key partners to address the needs of CYSHCN and their families in accessing, maintaining, and using the most appropriate form of health care coverage. As part of the project, ABC provides benefits counselors, Regional Centers, and collaborators with training and education. In addition, ABC provides direct health benefits counseling to under- and uninsured individuals. A MCH Title V Services Block Grant, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services helps support this project.
TLC for Kids is an outreach project of ABC for Health and HealthWatch Wisconsin to inform Wisconsin residents about the federal Lifeline and Link-Up programs, which provide affordable telephone service for low-income residents. Through daily communications with clients, and through the HealthWatch Wisconsin e-newsletter "The HealthWatch Update," ABC for Health is reaching a rapidly expanding population of Wisconsin residents eligible for Lifeline and Link-up services. ABC partnered with My Coverage Plan to produce a consumer-orientated eligibility screener for Lifeline, TEPP, & TAP services. Thanks, in part, to funding provided by the Universal Services Fund of Wisconsin.View ABC's Lifeline and Link-up Library.
This project, funded by the Children’s Health Insurance Program Reauthorization Act (CHIPRA), aimed to increase the number of children enrolled in health care coverage programs. To help achieve this aim, ABC for Health improved the scope and effectiveness of HealthWatch Coalitions across Wisconsin. Efficient, coordinated advocacy and enrollment in public safety-net programs begins with competent, up-to-date public health professionals working directly with families. The statewide HealthWatch Wisconsin organization promoted the CHIPRA project through an existing network of community-based coalitions in nine counties, connected health care workers across the state, and facilitated the development of local strategies to reduce barriers to enrollment. Learn more at HealthWatch Wisconsin’s website: www.healthwatchwisconsin.org. A Children’s Health Insurance Program Reauthorization Act Outreach and Enrollment Grant, HHS-2009-CMS-CHIPRA-0008, supports the CHIPRA project
Over a decade ago, Blue Cross Blue Shield of Wisconsin converted from a nonprofit health insurance provider to a for-profit business. As part of the conversion, Insurance Commissioner Connie O’Connell required that Blue Cross Blue Shield pay back to the public the more than $600 million in community benefits as a result of its tax-exempt status since the 1930’s. The Commissioner directed the $600 million of public money to Wisconsin’s two medical schools, the Medical College of Wisconsin and the University of Wisconsin School of Medicine and Public Health, and she ordered the schools to use the funds to "promote public health initiatives that will generally benefit the Wisconsin population." ABC for Health monitors the schools’ use of the Blue Cross Blue Shield conversion funds and advocates for increased funds for the public health community and the people of Wisconsin. Read more.
Sharon Mondry contacted ABC for Health after her insurance company refused to cover her son’s speech therapy. Her son, Zev, had stopped talking as a toddler. His doctors diagnosed him with autism and recommended that speech therapy would help him regain some ability to speak. Sharon and ABC repeatedly asked the insurance company to justify the refusal of coverage, but the company would not provide the documents it used as the basis of the coverage denial. In 2006, Sharon and ABC took the insurance company to court. In the lawsuit, eventually appealed to the U.S. Supreme Court, ABC’s Executive Director and public interest attorney Bobby Peterson argued[mp3] that the insurance company was legally obliged to provide the documents used to deny coverage of Zev’s speech therapy. The Seventh Circuit Court of Appeals agreed. The Court's decision, which still stands today, noted that health plans cannot "hide the ball" from plan participants and withhold the documents they need in order to appeal benefits denials. Sharon’s court case is not over yet. A few legal questions about fines and attorney’s fees remain to be resolved. But already her victory will ensure that other families fighting a benefits denial will not face similar refusals before they get plan documents they need to appeal a denial of services.