Special Enrollment Period for BadgerCare+ Transitioners Ends November 2

In September, the Centers for Medicare and Medicaid Services (CMS) announced a Special Enrollment Period for people who lost their BadgerCare+ coverage in April due to the eligibility changes made by the Wisconsin Department of Health Services (DHS). That Special Enrollment Period closes November 2nd.

An estimated 62,000 people throughout the state lost BadgerCare+ coverage in April, and approximately 60% of them did not re-enroll into Marketplace coverage, likely remaining uninsured and without access to compensated care.

These individuals will have until November 2nd to sign up for a Marketplace plan this year; otherwise, they must wait until November 15th to sign up for health coverage beginning on January 1st. They may also be subject to a tax penalty for not having health insurance during 2014.

A person who may be eligible for a Special Enrollment Period can start the process of buying insurance by calling the Health Insurance Marketplace at 1-800-318-2596. Please encourage them to do so as soon as possible!

2015 Marketplace Renewals and Re-enrollments

The second Open Enrollment period is coming up quickly! From November 15th, 2014 through February 15th, 2015, the Health Insurance Marketplace will be open for 2015 enrollment.  Those who remain uninsured, as well as anyone interested in learning about the new options, can apply during this time.

Consumers who enrolled last year may be wondering how to re-enroll or change plans for 2015. CMS released final rules on this process several weeks ago. Anyone enrolled in a 2014 Marketplace plan will receive letters from CMS and their insurer containing important information about this process.

The QHP’s letter will provide consumers with the 2015 premium for their current plan and remind them of their 2014 tax credit, which they will continue to receive (in most cases) if they take no action during open enrollment.

Going into open enrollment, it is important to recognize that tax credits will be recalculated.

Because of the new 2015 federal poverty level (FPL), and a likely change in the cost of the benchmark plan used to calculate tax credits, the tax credit amount for those with household income at a given percent of FPL will change for 2015. To receive the new 2015 tax credits, consumers must resubmit their application and enroll in a plan, even if they want to re-enroll in the same plan.

Below find answers to some common questions consumers may have about the re-enrollment process:

What are my options going into Open Enrollment?

During the enrollment period, there are several possible courses of action. You could renew your plan; update, switch, or cancel your plan; or take no action. Here’s what happens in each case:

  1. If you choose to simply renew your plan, and you attest that there has been no change in your income or household size, you will be re-enrolled for 2015 with your same 2014 tax credits.
  2. If you have household updates to report, want 2015 tax credits or want to look at the new options, you should update and resubmit last year’s application in order to see your new tax credits and plan options. (Please note that if, on the 2014 application, you claimed that your anticipated income was the same as reported on your 2012 tax return, the specific amount will not be listed on this year’s application either and you will need to refer to you 2012 tax return to determine if that amount is still correct).
  3. If you are currently enrolled in a marketplace plan and take no action during the 2015 enrollment period, you will be re-enrolled and receive your 2014 tax credits unless:
    • Your 2013 tax return indicates your income is over 500% FPL OR
    • You did not give the marketplace access to future tax returns at the end of last year’s application
    • In either of these cases, you will still be re-enrolled, but will not receive any financial assistance (Advance Premium Tax Credits or Cost Sharing Reductions).

If I take no action, in which plan will I be re-enrolled?

  1. If possible, the same QHP as last year.
  2. If your specific QHP is not available, you will be enrolled in a different version of the same product from the same insurer.
    • A plan in the same metal tier if possible
    • Otherwise, a plan that is one metal tier up or down from the old plan.
  3. If no version of last year’s product is available, you will be auto-enrolled in the most similar product available through the same insurer. The same metal tier policy applies as above:
    • A plan in the same metal tier if possible
    • Otherwise, a plan that is one metal tier up or down from the old plan.
  4. If neither of the above options is available, you would be auto-enrolled in the most similar product available through a different insurer.
    • Since none of last year’s marketplace insurers are going off the exchange, we should not have to worry about this case in Wisconsin.

If my household situation or income has changed, how do I report those changes?

Through the website or by phone.

Due to the challenges of following up on incomplete information received by mail, the final rule gives the Federally Facilitated Marketplace the option to reject changes submitted by mail.

After the Open Enrollment period begins, consumers will be able to preview the new options and monthly premium estimates here.

Wisconsin Faces Cuts in FoodShare Funding

Wisconsin is one of only four states nationwide that is enacting cuts to the food stamp (FoodShare) program. The food stamp cuts were passed as part of the massive Federal Farm Bill in February. The intent of the legislation was to save money by clamping down on states that were using certain provisions of a federal heating assistance program to increase food stamp benefits.

The Associated Press found that governors of 12 states have taken steps to avoid the cuts. In some cases, states are using their own money, saying they’re preserving benefits for their most vulnerable residents. The AP review said Wisconsin, Michigan, New Jersey, and New Hampshire are the only ones that did not try to work around the federal cuts.

But how does this affect our work at CKF? FoodShare eligibility is one of the federal benefits that qualifies school-age children for Free and Reduced Lunch as part of the National School Lunch Program. CKF has been working with Wisconsin’s Department of Public Instruction to connect children to free lunch via direct certification since 2011. Cuts to FoodShare mean fewer students are eligible for the healthy, nutritious meals they need to remain productive at school.

The good news is that students that were eligible for FoodShare at the start of this school year will remain eligible for free lunch for the rest of this academic year and the first month of school in 2015, regardless of whether or not they lose their FoodShare eligibility. The bad news is that unless Wisconsin leaders step in to avoid these cuts, untold numbers of kids will not be eligible for FoodShare and free lunch for next year.

For some kids, school is the only place they can get a fulfilling and nutritionally balanced hot meal.

Learn more about CKF’s Direct Certification Project at the webpage Questions about Direct Certification or how FoodShare relates to free lunch? CKF’s Direct Certification Specialists, Nikki and Helena, are happy to answer your questions. Please contact them at directcert@ckfwi.org.

New Special Enrollment Period for Former BadgerCare+ Members

Today, the Centers for Medicare and Medicaid Services announced a Special Enrollment Period for consumers who lost their BadgerCare+ coverage in April due to the Department of Health Services eligibility changes. This means those consumers have an opportunity to enroll in Marketplace coverage now, and do not have to wait until the next Open Enrollment period.  The Special Enrollment Period for those who lost their BadgerCare+ is available today, September 4th through November 2nd.

For applications made before the 15th of the month, coverage will begin on the first day of the month immediately following. For applications made after the 15th of the month, coverage will begin the next month. The next Open Enrollment period begins November 15th, 2014 with coverage starting no sooner than January 1, 2015.

An estimated 62,000 people throughout the state lost BadgerCare+ coverage in April, and approximately 60% of them did not re-enroll into Marketplace coverage, likely remaining uninsured and without access to compensated care.

If you know uninsured consumers and clients who lost their BadgerCare+, please spread the word and encourage them to apply for coverage in the Marketplace. These consumers are likely eligible for financial assistance to help pay the cost of premiums, co-payments and deductibles. Remind them there are many plans available in the Marketplace to choose from, and all plans cover essential health benefits like prescription drugs, preventive care, hospital stays and more.

Consumers should apply for this Special Enrollment period by calling 1-800-318-2596. Consumers looking for in-person enrollment assistance can dial 211 to find local help.

It can still be special! (Enrollment, that is.)

Even though the first open enrollment period is closed and the second is just about 3 months away, there are many situations that still allow someone to enroll in coverage for the first time or change coverage for very specific reasons.

Known as Special Enrollment Periods or SEPs, CKF has developed a handy Special Enrollment Summary chart that guides assisters through the essentials of determining if someone might be eligible for a SEP, and how to undertake gaining coverage.

And, here’s a handy flyer to remind people that they may still be special. Special enough for a SEP.

Courts Weigh In on ACA and Premium Subsidies – But Nothing Changes (Yet)

Earlier this morning, the DC Circuit Court of Appeals released a decision saying that the Affordable Care Act (ACA) only authorized health insurance subsidies for state-based Marketplaces, essentially rendering subsidies invalid in the 36 states with federally-facilitated and state-partnership Marketplaces. Just a few hours later, the Virginia Circuit Court of Appeals upheld the subsidies in federally-facilitated and partnership Marketplaces.

So, what does this mean for subsidies in Wisconsin, a federally-facilitated Marketplace?
Nothing, for now.

More on the cases:

Halbig v. Burwell (Decision here): Three-judge panel of the DC Circuit Court of Appeals: This panel voted 2-1 against the subsidies, agreeing with the plaintiffs that the text of the ACA does not permit federal subsidies outside of state-based Marketplaces. The federal government has stated that it will request an “en banc” review of the decision – meaning all eleven DC Circuit Court judges would review the decision, potentially reversing the decision of the three-judge panel.

King v. Burwell (Decision here): Three-judge panel of the Virginia Fourth Circuit Court of Appeals: This panel voted 3-0 to uphold the subsidies, agreeing with the Obama Administration that the law does not limit the subsidies to state-based Marketplaces. The plaintiffs could request an “en banc” review of this decision as well, to have all judges in the Circuit Court review and rule.

These cases are, indeed, contradictory.

And there are more cases on the legality of subsidies still pending: Pruitt v. Burwell (US District Court Eastern District of Oklahoma) and Indiana v. IRS (US District Court Southern District of Indiana).

Next Steps:

These cases will likely both be heard and decided by all eleven judges in each jurisdiction, and could result in reversal or upholding of the three-judge panel decisions. Cases that have differing and contradictory rulings at the District Court of Appeals levels are more likely to be reviewed by the Supreme Court – however, the Supreme Court could decide to hear the case regardless of Court of Appeals’ opinions. Whether or not the Supremes hear this issue is unclear.

Why this Matters:

In our Federally-Facilitated Marketplace in Wisconsin, subsidies make a difference in people choosing to purchase health insurance through the Marketplace. According to the Summary Enrollment Report Addendum, 91 percent of Wisconsinites who selected a Marketplace plan had financial assistance through the subsidies. Avalere Health estimates Wisconsin consumers would see a 70-74 percent increase in premiums if the subsidies were deemed invalid outside of state-based Marketplaces. These cases could potentially have big consequences on the ACA – but not yet.

Want to read more? Vox.com is providing great news coverage and analysis of the decisions, as well as the National Health Law Program., and the Kaiser Foundation offers this Q&A.

Coverage to Care- New Resources!

Thousands of Wisconsinites signed up for health insurance coverage during the first Open Enrollment period and more are continuing to enroll in BadgerCare+ or in the Health Insurance Marketplace through a special enrollment period. Many of these consumers are accessing insurance coverage for the first time. A recent study by the Kaiser Family Foundation reported that nearly 60% of new enrollees were previously uninsured. With an influx of newly insured individuals into the health care market, many are confused about using their coverage.

How do I find a provider? How much does my insurance cover for my doctor’s visits? What is a deductible? Are my prescriptions covered? When should I use the Emergency Room?

Oftentimes consumers will seek out assistance from advocates, providers or enrollment assisters they have trusted in the past, meaning they will be coming back to you with their questions. Before they do, make sure you are prepared by exploring new resources from the Centers for Medicare and Medicaid Services, Coverage to Care (C2C).

C2C is a new initiative launched to answer questions consumers have about using their new health insurance. Check out their Roadmap to Better Care and a Healthier You, a comprehensive 8 page brochures which shares consumer friendly information on understanding an insurance plan, finding a provider, scheduling an appointment, and other resources to make health insurance more understandable. Additional publications and videos can be accessed here. And, if you want to order material, free of charge, do so here.

For more information and materials about health insurance access and additional outreach materials, visit http://www.ckfwi.org.

BadgerCare+ Enrollment Numbers Released

The Department of Health Services released April’s BadgerCare+ enrollment numbers today. The release of these numbers has been anticipated because the numbers reflect the effect of the April 1 BadgerCare+ eligibility changes.

Remember, the April 1 changes modified eligibility for BadgerCare+ to 100% FPL, providing access to coverage for many, but eliminating access to coverage for some.

So, what story do the numbers tell? Are more people insured? And, who’s left out?According to DHS’s data (found here), as of April 2014, 81,731 Wisconsin childless adults now have health insurance coverage through BadgerCare+. These are the childless adults who were previously ineligible, many who were uninsured and on a waitlist for coverage.

The April 1 changes ended the waitlist and opened up coverage to anyone with an income below 100%FPL ($11,670/year) for parents or for childless adults. It’s important to remember that these numbers may increase throughout the year because BadgerCare+ has continuous enrollment – meaning a person can apply for and enroll in BadgerCare+ any time throughout the year, not just during Open Enrollment.

Though good news to many new enrollees, the eligibility changes also resulted in some parents losing coverage. Because the new income limit is 100% FPL, adults with incomes between 100-200% FPL were removed from their BadgerCare+ coverage April 1. DHS reported 62,776 parents lost their BadgerCare+ coverage.

Because losing coverage is considered a qualifying event, those parents were informed they had 60 days (until May 30) to apply for new coverage in the Health Insurance Marketplace. These individuals will be eligible for financial assistance when purchasing their new plans if their income is still below 400% FPL.

There is some concern about whether these parents will apply for new coverage and whether it will be considered affordable. If you are working with individuals who lost their coverage and are looking for assistance, encourage them to seek out a Certified Application Counselor or Navigator to discuss their options. Local help can be found by dialing 2-1-1 in most parts of the state, or by contacting the National Call Center at 1-800-318-2596.  Applications can be completed online at http://www.healthcare.gov.

Check out CKF’s Fact Sheets for more information, also found at www.ckfwi.org.


Community Eligibility: Free Lunch and Breakfast in Eligible Wisconsin Schools

CKF has been working with Wisconsin’s Department of Public Instruction (DPI) to connect children to healthy, free school meals via direct certification (DC) since 2011. Direct Certification is the web-based process by which children are deemed eligible for free meals under the National School Lunch Program without paper applications. Now, a new and exciting opportunity called Community Eligibility is on the horizon for high poverty schools and districts in Wisconsin that will connect even more children to healthy, free school meals. 

 The Community Eligibility Provision (CEP) allows high poverty schools and districts to offer breakfast and lunch to all students at no charge. CEP was piloted in 2011-2012 and is now available to schools in all states for the 2014-2015 school year.

 CEP is a 4-year reimbursement option for eligible schools participating in both the National School Lunch Program (NSLP) and School Breakfast Program (SBP) that wish to offer free school meals to all children in high poverty schools without collecting household applications. To participate in CEP, schools or districts must have a student population where at least 40 percent are eligible for free school meals without an application. Those eligible without an application include students that are in Head Start, students classified as homeless or migrant, and students directly certified for free meals because they are living in a household that receives FoodShare or W-2 cash assistance or based on their status as a foster child. 

 Schools or districts have until June 30, 2014, to apply for CEP for the 2014-2015 school year.

 Here’s a list of Wisconsin schools eligible to participate in CEP: 

 For further information and to download the CEP Application Form, please visit DPI’s Community Eligibility webpage http://fns.dpi.wi.gov/fns_cep.

CEP Report.

Small Doses About the Role of Tax Credits When Obtaining Health Insurance on the Markeplace Seen on IRS YouTube Videos

The Internal Revenue Service (IRS) has posted four Tax Credit videos on YouTube – three explain the Advanced Premium Tax Credit (APTC) in English, Spanish and American Sign Language, in under 2 minutes. If you purchase health insurance through the Health Insurance Marketplace, you may be eligible for the tax credit. The fourth video explains the Small Business Tax Credit in English in 2 1/2 minutes.

Premium Tax Credit – IRS English YouTube Video

Premium Tax Credit – IRS Spanish YouTube Video

Premium Tax Credit – IRS ASL (American Sign Language) YouTube Video

Small Business Health Care Tax Credit