Today, the Department of Health Services (DHS) announced a final agreement with the federal Centers for Medicare and Medicaid Services (CMS) on the waiver to make changes to BadgerCare+. Though the state changes to the program were proposed and enacted through the biennium budget in June 2013, BadgerCare+ is a joint state and federal program, so all changes had to be negotiated and approved by CMS.
Due to technical issues with the federal Marketplace website, the changes to BadgerCare+ coverage have essentially been delayed for three months through state legislation passed in December. We blogged in December about the delay in coverage of childless adults under BadgerCare+ and the transition of parents/caretakers with income above 100% FPL to the Marketplace as it was passed into law. The waiver language confirms this- that childless adults with incomes below 100% FPL will be eligible for BadgerCare+, without an enrollment cap, on April 1, 2014.
CKF’s 10 Things to Know document summarizes the effects of the 2014 changes to BadgerCare+.
The waiver also ensures that all BadgerCare+ enrollees (including children) will have access to the full Standard Plan benefit package, which is more robust than the current Benchmark and Core Plan benefits.
The agreement between the state and federal government also updates progress on the state’s transition to assessing eligibility under the new Modified Adjusted Gross Income (MAGI) standard – which will apply to BadgerCare+ enrollees, and not the Elderly, Blind, and Disabled Medicaid population. The MAGI system will be operational February 1, 2014. In order to assess currently eligible BadgerCare enrollees for future eligibility using the new standard, the state is asking all current BadgerCare enrollees to complete this form and return it by January 17, 2014. This will take an amendment to state law that has been approved by the Wisconsin Joint Finance Committee, and will need full legislative approval.
Here are a couple things to know about the MAGI transition and key eligibility dates:
· January 17th – Current BadgerCare+ enrollees who received this letter should return the tax filer information form to have their eligibility reassessed under MAGI.
· February 1st – MAGI will be implemented and all newly enrolling adults/caretakers will be assessed under MAGI with the BadgerCare+ adult income standard at 100% FPL instead of the current 200% FPL.
· March 15th – Currently enrolled BadgerCare+ parents/caretakers with incomes above 100% FPL should enroll in a Marketplace plan with federal subsides to help afford coverage. If these individuals fill out the tax filer information form and are found to have income above 100% FPL under MAGI rules, their information should have been automatically transferred to the Marketplace.
· April 1st – Currently enrolled BadgerCare+ parent/caretakers with incomes above 100% FPL will no longer be eligible for BadgerCare+.
· April 1st – Newly eligible childless adults with income less than 100% FPL will be eligible to start BadgerCare+ coverage. Current BadgerCare+ Core Plan members with incomes below 100% FPL will be automatically transferred to the full Standard Plan.
More details about the MAGI transition and agreement can be found in the Legislative Fiscal Bureau papers on the technical bills currently before the legislature.
Further Waiver Policy – Transitional Medical Assistance (TMA)
Wisconsin currently charges premiums to TMA adults with incomes above 133% FPL, and requested, through the waiver, to charge premiums to all TMA adults above 100% FPL. However, the final agreement allows Wisconsin to charge scaled premiums to adults between 100% and 133% FPL only after six months on TMA. This may become a moot point if congress doesn’t reauthorize the option of providing TMA to some adults for 12 months (as Wisconsin currently provides). To learn more about that federal discussion, see the Center on Budget and Policy Priorities recent report.
If you want to read more on the technical details of the waiver agreement, the special terms and conditions can be found here.