BadgerCare Plus: Important Information Overview

BadgerCare Plus Overview January 2020 1

Roadmap for Todays Training BC+ financial and non-financial eligibility rules, BC+ issue-spotting, and DBS And EBS role in BadgerCare Plus (BC+) 2

Why is BadgerCare+ Important? BC+ is the Medical Assistance (MA) coverage option for low-income: Children ages 0-19, Parents, Caretaker Relatives, Pregnant Women, & Childless Adults. BC+ is the largest MA program in Wisconsin* *But many people don t know they re eligible! 3

Why is BadgerCare+ Important? (cont.) BC+ is full-benefit Medicaid providing the full range of MA-covered services. BC+ is an income means-tested program including those without a disability determination. 4

BC+ vs. EBD MA There are distinct differences between EBD MA financial eligibility rules and for BC+ This presentation will focus on BC+ rules 5

Background BadgerCare began in 1999 The Affordable Care Act of 2010 and actions on the state-level have made significant changes to the BC+ program: Modifying income limits for various BC+ groups. All BC+ members now receive the Standard Plan (full-benefit MA). New: A CMS Childless Adult BadgerCare Plus Waiver was approved on 10/31/18 (more on that later!) 6

Background (cont.) The ACA resulted in MAGI income counting/household composition rules to align eligibility rules with IRS tax code-based policy in the Marketplace 7

BC+ has a Major Difference from EBD MA . There is no asset nor resource test for BC+ BC+ only considers MAGI Income and Household Size when determining financial eligibility Also, BC+ is a means-tested Medicaid program, it does not require a disability determination 8

Financial Eligibility for BC+ 1. Parents & Caretaker Relatives (100% FPL) 2. Childless Adults (100% FPL) 3. Pregnant Women (306% FPL)* 4. Children (306% FPL)* *We will focus on parents, caretaker relatives and childless adults 9

2019 Federal Poverty Levels-Effective 2/1/20 Family Size 100% FPL 120% FPL 150% FPL 200% FPL 300% FPL 306% FPL Annual 135% FPL 1 $12,490 $1,040.83 $1,249.00 $1,405.12 $1,561.25 $2,081.66 $3,122.49 $3,184.94 2 $16,910 $1,409.17 $1,691.00 $1,902.38 $2,113.76 $2,818.34 $4,227.51 $4312.06 3 $21,330 $1,777.50 $2,133.00 $2,399.63 $2,666.25 $3,555.00 $5,332.50 $5439.15 4 $25,750 $2,145.83 $2,575.00 $2,896.87 $3,218.75 $4,291.66 $6,437.49 $6566.24 10

Parents & Caretaker Relatives Eligible at or below 100% FPL Full benefit Medical Assistance No premiums Co-pays from $.50 to $3.00 No insurance access and coverage test Parents and caretakers can have both Medicare and BC+. >100% FPL must look at other health insurance options, including the Marketplace 11

Childless Adults Eligible at or below 100% FPL Full benefit Medical Assistance Co-pays from $.50 to $3.00 No insurance access and coverage test If eligible for Medicare, cannot have BC+ >100% FPL must look at other health insurance options, including the Marketplace 12

Changes for Childless Adults Will now have a premium of $8.00 per month Emergency Room Copay for non- emergencies- $8.00 Many will have to fill out a treatment needs questionnaire 13

Does Ms. Ludgate qualify for BadgerCare Plus She is 30 years old Her income per month is $1,039.00 She has no children She lives by herself 14

Temporary Suspension of Copays From January 1, 2020 until July 30, 2020 Health care providers may not collect any copays from you for services during this time period This includes Childless adults as well 15

A Word About MAGI The rules governing BC+ income counting and household composition fall under Modified Adjusted Gross Income (MAGI) These follow IRS rules, with some exceptions Most notably, SSDI and SS Retirement count 16

Other Policies Transitional Medical Assistance for those who exceed income limits due to increases in earned income or spousal maintenance 63,771 statewide total (Feb 2019) Premiums-above 133% FPL Youth Exiting Foster Care age limit increased to age 26 923 statewide total (Feb 2019) Express Enrollment provided at hospitals 17

If found ineligible Any member identified as ineligible for BC+, but for whom the CARES system shows a disability determination, will be screened for EBD MA eligibility by the appropriate IM consortium. The IM agency must follow-up and request any verification necessary to determine eligibility for these EBD MA programs. If over income and no disability, refer to ACA. 18

When Can I Apply? Unlike the Marketplace, which has an open enrollment period and possible special enrollment periods BC+ applications are always accepted and can be initiated at any time. Unsure about BC+ eligibility? There is no harm in applying: When in Doubt, Apply and Find Out! 19

Can Ms. Knoppe apply for BadgerCare Plus? Ms. Knoppe has three people in her household including a child She makes $2200.00 per month It is past open eligibility enrollment period for Medicare. 20

How Do I Apply? Via www.access.wi.gov (preferred method) By Mail, Phone or In-Person You can request a paper application, IM agency hotline, and fax number by calling: 1-800-326- 3002 To apply in person, visit your local IM agency Note: IM agencies are obligated to provide reasonable accommodations for people with disabilities and those who require interpretation 21

BC+ & HMOs Nearly all BC+ members are asked to select an HMO in a mailed notice, HMOs vary throughout the state. If a plan is not selected in 30 days, member is auto-enrolled. 22

BC+ & HMOs (cont.) Once enrolled, there is a 90 day window to change HMO selection For help selecting or switching HMOs, contact 1-800-291-2002 (DHS Member Services) 23

BC+ & HMOs (cont.) Members can choose new HMO at recertification or re-enrollment following termination Medicare eligibility triggers disenrollment from an HMO (recall that only parents/caretaker relatives can have both Medicare and BC+ simultaneously) 24

Due Process Rights for BC+ BC+ applicants and recipients have a right to a Fair Hearing before an Administrative Law Judge. Hearing requests must be filed within 45 days from effective date of the adverse action. Unlike SSA hearings, there is no good cause late filing exception. 25

Your Due Process Rights (cont.) Practice Tip: File a Fair Hearing beforethe termination date listed on notice to receive continued coverage pending appeal 26

CMS BadgerCare Plus Waiver Reforms Community engagement (employment and training requirement) including a 48-month limit on benefits when in non-compliance Monthly premiums A mandatory question about drug use Healthy behavior incentives applied as a reduction in the monthly premium amount An $8 co-payment for non-emergency use of the emergency department 27

DBS and BadgerCare+ According to the Scope of Services, DBSs can: refer applicants to Income Maintenance; give general and client-specific information; assist with applications, renewals and appeals; & provide advocacy on BC+ matters. DBSs should be knowledgeable about BC+ and contact your program attorney as needed 28

EBS and BadgerCare+ Someone who turns 65 or becomes eligible for Medicare via disability loses eligibility for BC+, and income maintenance doesn t necessarily flag this so clients need to be aware that they may have to report this. Someone who is >65 or on Medicare via disability can still be nonfinancially eligible for BC+ if they re a caretaker relative (but it doesn t mean they can postpone or drop Part B). 29

As a Reminder.: 30

When in Doubt, Apply to Find Out! The best advice for people with disabilities who are unsure if they are newly eligible, or continue to remain eligible, is to apply there is no harm in applying. Remember, there is no deadline to apply for BC+! 31

Resources BadgerCare Plus Handbook: http://www.emhandbooks.wisconsin.gov/bcplu s/bcplus.htm ForwardHealth Portal: https://www.forwardhealth.wi.gov/WIPortal/ DHS BadgerCare Plus Homepage: http://www.dhs.wisconsin.gov/badgercareplus/ CMS Childless Adult Waiver FAQs: https://www.dhs.wisconsin.gov/badgercareplu s/waivers-cla.htm 32

End of Presentation These materials are current as of 1/7/20 Any questions contact Amanda Luedtke 414-292-2723 amandal@drwi.org Thank you! 33