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Medicaid, SCHIP, & Federal Authority

  • Section 1115 Waiver - In 2008, Wisconsin transformed its Medicaid and State Children’s Health Insurance Program (SCHIP) program by implementing BadgerCare Plus.  Wisconsin built upon its previous section 1115 waiver program, Wisconsin BadgerCare program, to create a streamlined statewide coverage initiative.  BadgerCare Plus utilizes a managed care delivery system to provide easy access to health care for lower income adults and all children.  This initiative uses federal match from SCHIP and Medicaid to expand coverage to new populations.  The state seamlessly integrates state-only funded programs into the overall program to assure access.  Enrollees in BadgerCare Plus receive benefits either through the Standard Plan or the Benchmark Plan, depending on income level.  

    As part of BadgerCare Plus, Wisconsin extended coverage to all children in the state beginning in February 2008.  Children in families with lower incomes are covered with Medicaid and SCHIP funding. Children in families whose income exceeds this amount are covered with state-only funds.  Under the section 1115 waiver program, Wisconsin has expanded eligibility levels for custodial parents of eligible children with net family incomes, and the uninsured spouses of such parents, up to 200 percent of the FPL.   

    Deficit Reduction Act (DRA) of 2005As part of its overall transformation to BadgerCare Plus, Wisconsin increased eligibility for pregnant women up to 300 percent of the FPL (federal match is only up to 250 percent).  In conjunction with this eligibility expansion, Wisconsin received approval from the Centers for Medicare and Medicaid Services (CMS) to implement a Benchmark plan for pregnant women between 200 and 300 percent under the benefit flexibility provision of the DRA.  Wisconsin’s Benchmark plan for pregnant women is consistent with the benefits of the largest commercial plan offered in the State with some additional benefits, including mental health and substance abuse coverage comparable to that of the state’s employee health plan. To receive benefits under Medicaid, pregnant women between 200 percent and 300 percent of the FPL are required to enroll in the Benchmark plan. Children in families earning above 200 percent of FPL are also enrolled in the Benchmark Plan.  Children, parents and pregnant women below 200 percent of FPL are enrolled in the Standard Plan.

    BadgerCare Core Plan for Childless Adults.  The state passed legislation to expand coverage to all childless adults up to 200 percent of FPL.  Due the downturn in the economy the coverage expansion will be implemented in phases.  During the first phase, the approximately 7,000 adults currently enrolled in the GAMP program (see below) will be enrolled in the BadgerCare Core plan on January 1, 2009.

High-Risk Pools

  • Wisconsin’s high-risk pool, the Wisconsin Health Insurance Risk Sharing Plan (HIRSP) became operational in 1981 and provides a choice of three benefit coverage options.  The pool is financed through policyholder premiums, assessments on insurers, and provider discounts.  Premium subsidies are available for qualified low income policyholders. The premium cap is set at 200 percent of the rate that a standard risk would be charged under a policy providing the same coverage deductible.  At the beginning of 2008, almost 17,000 persons were enrolled in the program.   About 2,800 of them received premium subsidies.

Group Purchasing Arrangements

  • In 2003, Wisconsin Governor Jim Doyle (D) signed legislation into law that creates five regional health care purchasing alliances to bring farmers and small businesses into one pool per region. These cooperatives allow groups to directly negotiate with health plans. In 2005, Governor Doyle passed new legislation that removes limits on the number of cooperatives that can be developed in the state. By encouraging the establishment of cooperatives, the hope is that not only will more uninsured individuals access health insurance, but also that competition will increase among carriers and create more options for coverage.


State Specific Strategies

  • General Assistance Medical Program (GAMP) – The GAMP is a community safety-net system for uninsured residents in MilwaukeeCounty.  To be eligible for coverage an individual must be uninsured and have a family income below 90 percent FPL, depending on family size ($902 for one person).  GAMP covers services such as primary care and clinic services, inpatient and outpatient hospital care. GAMP is funded by state and federal Medicaid revenues as well as MilwaukeeCounty tax levy.   At any given point in time, there are between 7,000 and 10,000 individuals enrolled in GAMP.  The state is planning to incorporate GAMP into BadgerCare Plus in January 2009.