HealthWatch Wisconsin's
Update Newsletter
"Your trusted source for health care coverage updates and strategies."
Wisconsin Sends BadgerCare Plus Waiver to Feds

After a delay, presumably to review the over 1,000 public comment received on its BadgerCare Plus Demonstration Waiver, Wisconsin's Department of Health Services (DHS) submitted its waiver request to the Feds on Wednesday, June 7.

 

The waiver was in slightly different form than the original. The public comments were not made public, only an 8 page summary was posted on the DHS website. The feds have 15 days to determine if the waiver request is complete and to notify the state. The start of a new, federal 30 day comment period will then begin. If the application is not complete, the Centers for Medicare and Medicaid Services (CMS) will notify DHS of any missing elements in the application. 

The modifications DHS made slight modifications to the original waiver are extremely slight, and as minimal response they could give after cherry picking through the comments.

 

We presume the public comments were more vocal, especially on areas of work requirements, drug testing, and the ER "cover charge." DHS has posted a partial "summary" of public comments, but did not post all of the 1000+ comments they said they received.

 

(Read the full version)

Medicaid at Risk!
Pay Attention!
Deadline Maintenance

In this new, regular feature of the Update newsletter, we’ll call to your attention key deadlines on the horizon! Knowing some critical dates could be the difference between coverage and uncompensated care for a patient. Keep these dates on your radar:

 

Friday, June 30: is the "last business day of the month!" Consumers and advocates will need to submit applications for key public benefits programs by close of business at local consortia, typically 4:30pm in the afternoon, to ensure coverage for the month of June.

 

Also: Are you applying for BadgerCare Plus and requesting backdating? If you submit an application for BadgerCare Plus before the end of the day June 30, you can request coverage back to March 1!

 

Other BadgerCare Plus Deadline Reminders:

  • Are Verifications Due? An often-forgotten deadline is the one to submit verification items to a local Income Maintenance Consortium after someone has applied for BadgerCare Plus. The Consortium will typically allow 10 days to provide verifications!
  • Is a Full BadgerCare Plus Application Due? If an application was started through “Express Enrollment” or “Presumptive Eligibility” where an express enrollment application was submitted, an individual still needs to complete a full BadgerCare Plus Application! The temporary enrollment continues only to the end of the month following the month of application.

More on Backdating Coverage:
What is "backdating?" Some people determined eligible for BadgerCare Plus may be able to have coverage that is retroactive! Generally, the rule is: a consumer is eligible for up to the first of the month, three calendar months prior to the month of application. If their family income was at or below the threshold for each of those months.

 

For Children: backdating is determined by age and income.

 

For Adults: Almost anyone at or below 100% FPL can backdate as long as they would have been under the threshold for each of those months!

(Read the full version)

Speak Up!
CMS Seeks Public Comments on Regulatory Burdens of the ACA

The Center for Medicare and Medicaid Services (CMS) posted a request for public comments concerning potential changes to current Department of Health and Human Services regulations that would reduce burdens of the existing regulatory structure of the ACA. The CMS posted the request for information, entitled "Reducing Regulatory Burdens Imposed by the Patient Protection and Affordable Care Act & Improving Healthcare Choices to Empower Patients," on June 8, 2017 at the Federal Register.

 

This request springs from President Trump's Executive Order 13765, entitled "Minimizing the Economic Burden of the Patient Protection and Affordable Care Act pending Repeal," of January 20, 2017. The President directed heads of all executive agencies and departments with duties under the ACA to pursue the following goals: allowing the states greater flexibility to create a health care market that’s more open and free than the current market, decreasing the ACA's financial requirements on anyone involved in the healthcare system, cooperating with states as they implement healthcare programs, and generally encouraging a free, open interstate market for healthcare services and coverage.

 

Health Insurance Regulation: ERISA and Church Plans

For the past 30 years, hospitals with religious ties have been considered exempt from federal pension requirements under the Employee Retirement Income Security Act (ERISA) "church plan" exemption.  ERISA sets minimum standards for employee benefit plans, including pension and group health plans, with the goal of protecting employees and employee rights under those plans.

 

Enacted in 1974, the act explicitly allowed "church plans" exemptions from its requirements, with "church plans" being defined as any plan "established and maintained for its employees by a church."  However, a 1980 amendment broadened that definition to include "plan[s] maintained by an organization ... controlled by or associated with a church."

 

In a June 2017 case, Advocate Health Care Network v. Stapleton, the U.S. Supreme Court unanimously affirmed that hospitals with religious affiliations exist in ERISA's "church plan" exemption. This decision means that religiously affiliated hospitals can avoid premium payments to the Pension Benefit Guaranty Corporation and still satisfy ERISA. 

 

Impact of the AHCA: Seniors & Children 

Under the AHCA, coverage for two of our most vulnerable populations would be less accessible. Programs that benefit both children and seniors, many of which are funded by Medicaid, would see substantial cuts under the AHCA that threaten to undermine existing sources of care and support. For example, Medicaid currently covers 30 million children and is the number one insurer of pediatric care in the nation.

Senators Announce Legislation to Strengthen the ACA

Senators Tammy Baldwin (D-WI), Dianne Feinstein (D-CA), Patrick Leahy (D-VT), Elizabeth Warren (D-MA), Kamala Harris (D-CA) and Maggie Hassan (D-NH) announced new legislation today with the intent of strengthening the Affordable Care Act.

 

The legislation aims at making coverage under the ACA more affordable to middle class individuals and families by restricting the amount an individual or family could pay towards insurance premiums to 9.69% of monthly income, which is currently the maximum contribution households must make toward their insurance plan if between 300 and 400 percent of the federal poverty level. 

 

The legislation also takes aim at sharp age cut-offs that define levels of financial help and can result in a substantial number of individuals and families facing much steeper premiums than what they can realistically afford. 

Watch This: Lifeline & TEPP/TAP
You may have heard of the Lifeline program, but what is it? Lifeline is a federal telephone assistance program that provides either a discounted phone service or a free cell phone for qualified individuals!

Brynne details covered service, eligibility criteria, why this under-utilized service is important, and more..

Another telecommunications assistance program is TEPP. TEPP helps people with disabilities get access to specialized equipment which allows them to use basic phone service or telecommunications. This program is run through the Universal Services Fund.

Brynne explains who's covered and what's covered in this video case tip.

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