| Vol. 13, No. 15
|August 15, 2017
Welcome to the HealthWatch Wisconsin Update Newsletter, a bi-monthly publication with exclusive features for members of HealthWatch Wisconsin.
2017 - 2018 HWW Membership Registration Now Open!
In this issue...
TOP STORY: HealthWatch Membership Registration Now Open
A New HealthWatch Membership Year Begins Oct. 1!
Registration for the new HealthWatch Membership year is now here! Take advantage of state of the art communication, networking, and training designed to amplify efforts and empower those working to help connect Wisconsinites to health care and coverage.
The HealthWatch Wisconsin membership year runs October 1, 2017 - September 30, 2018.
We're excited to announce that HealthWatch membership includes:
- Two FREE Live, in-person workshops
- Comprehensive online video trainings
- Publications, fact sheets, and resources
- Comprehensive newsletter and discussion of current events
- Substantial Discounts on the HealthWatch Annual Conference
Starting October 1, HealthWatch Wisconsin is becoming HealthWatch Wisconsin, Inc.!
We are excited to transition HealthWatch Wisconsin from a project of ABC for Health, Inc. to a non-profit, 501(c)3 subsidiary of ABC for Health. In its new arrangement, HealthWatch Wisconsin, Inc. will have a new Fiscal Year that begins October 1. What a great time to have new membership begin! As its own nonprofit, HealthWatch Wisconsin, Inc. will provide you with enhanced member benefits, including more frequent educational content.
Getting Ready for Open Enrollment
Open enrollment is just around the corner! The shortened open enrollment period begins November 1 then ends December 15. In our latest Video Case Tip, we offer advice, strategies, and tips to prepare for open enrollment as well as discuss why the period is so short.
Need additional help getting started? Here is a Marketplace Application Checklist, courtesy of CMS. Finally, we provide a list to your Wisconsin Navigators below. Remember, reach out early and get your appointment scheduled ASAP.
Insurers "Hedge Their Bets" As Feds Delay Decision on CSR
CBO Points Out The "Catch 22" of Eliminating CSRs
Instead of definitively protecting Cost Sharing Reductions (CSR) in the Marketplace, the Trump Administration instead last week announced they would be giving insurance companies more time to calculate price increases for 2018 coverage based on the uncertainty caused by President Trumps threats to cut CSRs. Insurance companies have until September 5 to file their rate requests. In Wisconsin, insurers are filing their rates with the assumption of unfunded CSRs.
Insurance companies exiting the 2018 Marketplace Open Enrollment period blame Marketplace instability as a reason – mainly, the lack of clarity on whether the Trump Administration will continue to pay cost sharing reductions (CSR). Insurance plans remaining in the Marketplace suggests premium increases of 20% or more to "hedge their bets" should the Administration defund CSR entirely. The ACA originally funded CSRs through 2019 before being eliminated.
In the meantime, CSRs continue to be tied up in court. In November 2014 that US House filed suit against the Obama Administration over CSR, arguing that Congress never appropriated money to fund them. Now, two and a half years later, the lawsuit is still on hold, largely due to House Republican and Trump Administration legal requests to delay any decisions on the case, a move most Democrats are calling a tactic to sabotage the ACA at a time when marketplace stability is front and center.
A new analysis by the Kaiser Family Foundation has pinned premium increases in the individual insurance market directly on the President. According to the report, "Insurers in this market face new uncertainty in the current political environment and in some cases have factored this into their premium increases for the coming year. Specifically, insurers remain about enforcement of the individual mandate (which brings down premiums by compelling healthy people to buy coverage) by the Trump Administration. Additionally, insurers in this market question whether the Trump Administration will continue to make payments to compensate insurers for cost-sharing reductions (CSRs), which are the subject of a lawsuit, or whether Congress will appropriate these funds. The vast majority of insurers included in this analysis cite uncertainty surrounding the individual mandate and/or cost sharing subsidies as a factor in their 2018 rates filings. Some insurers explicitly factor this uncertainty into their initial premium requests, while other companies say if they do not receive more clarity or if cost-sharing payments stop, they plan to either refile with higher premiums or withdraw from the market."
What could be done to reduce uncertainty and stabilize the markets once and for all? Congress could provide money for the CSRs. As reported by the New York Times, doctors, hospitals, insurers, consumer groups, the US Chamber of Commerce, and "influential chairmen of three congressional committees: Senator Lamar Alexander of Tennessee and Reps. Kevin Brady of Texas and Greg Walden of Oregon, all Republicans," support the funding of CSRs.
But, timing is making immediate congressional action unlikely. Congress is on their August recess until September 5, the same date rate filings are due.
Late Breaking Update:
The Congressional Budget Office on August 15 released its report on the impact of eliminating Cost Sharing Reductions. The report findings match the projected 20% premium spike for silver plans also predicted by the Kaiser Family Foundaion for eliminated CSRs.
The CBO states, "Because they would still be required to bear the costs of CSRs even without payments from the government, participating insurers would raise premiums of "silver" plans to cover the costs....According to CBO and JCT’s projections, for single policyholders, gross premiums...for silver plans offered through the marketplaces would, on average, rise by about 20 percent in 2018 relative to the amount in CBO's March 2016 baseline and rise slightly more in later years."
The CBO continued to provide a fiscal impact to the potential change in policy. Eliminating CSRs would increase the federal deficit by $194 billion in the next 10 years. The largest reason for the increase: if premiums go up, tax subsidies would too. The raise in tax subsidies the federal government would owe could supersede the CSR payments.
The CBO continues, "Total federal subsidies for health insurance in the nongroup market—in particular, the sum of the premium tax credits and the CSR payments—would increase for two reasons: The average amount of subsidy per person would be greater, and more people would receive subsidies in most years.
Because the tax credits would increase when premiums for silver plans rose, the agencies estimate that the average subsidy per person receiving premium tax credits to purchase nongroup health insurance would increase. Increases in those tax credits for people with income between 100 percent and 200 percent of the FPL would roughly offset the reductions in CSR payments. However, increases in premium tax credits for those with income between 200 percent and 400 percent of the FPL would substantially exceed the small reductions in CSR payments for this group."
For more information on Cost Sharing Reductions, watch our Video Case Tip:
Chipping Away at CHIP?
The clock is ticking on the Children's Health Insurance Program (CHIP). As CHIP celebrates its 20th anniversary this week, it approaches its sunset date of September 30. The future of the program in currently in the hands of the Senate Committee on Finance, a Committee that until now hasn't even confirmed that a discussion of reauthorization of CHIP would make it on their calendar before the program sunsets on September 30. Recall, the Senate Committee has postponed previous attempts to take up the reauthorization, and sources are still suggesting that CHIP reauthorization may be a "vehicle for changes to the Affordable Care Act." It is, after all, before the same Senators who vowed to repeal and replace the Affordable Care Act by almost any means necessary. For some, that may even include jeopardizing the health of the over 9 million children currently enrolled in the CHIP program across the United States.
The Children's Health Insurance Program (CHIP) provides health coverage to children and families with moderate to low incomes. In Wisconsin, CHIP is incorporated into the BadgerCare Plus program. Congress enacted CHIP in 1997 with bipartisan support and with the help of First Lady Hillary Clinton. Congress reauthorized CHIP in 2009, and by 2016, the program covered over 9 million children.
This week, Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Oregon) announced that CHIP would be on their Committee's calendar the first week of September.
In addition, Senators Hatch and Wyden publicly affirmed their strong, bipartisan support for the program. In a press release posted on the Committee's webpage, Sen. Hatch says, "In a time of polarization and partisanship, especially with issues related to health care, CHIP is a proven program that delivers high-quality coverage to vulnerable children in Utah and across the country…. I will be pushing to ensure action is taken to reauthorize CHIP in a bipartisan fashion." Sen. Wyden added, "I share Chairman Hatch's commitment to a strong, bipartisan, and timely CHIP extension."
This is good news for continued support for the bi-partisan program. The Medicaid and CHIP Payment and Access Commission also recommends that Congress extend CHIP funding through 2022. They estimate that if CHIP ends on September 30, over 1 million children would be instantly uninsured, without any other option for coverage.
Now, the clock really is ticking. Congress has 45 days to reauthorize CHIP.
BadgerCare Plus Enrollment Data - July 2017
BadgerCare Plus enrollment continued a four month decline in July, losing nearly 2,000 enrollees.
Children enrolled declined for a third month in a row. We expect to see enrollment decline once more in August, only to make small gains with children heading back to school at the end of the summer; during this time, BadgerCare Plus coverage traditionally makes gains at this time.
Childless adults and parents/caretakers enrolled in BadgerCare Plus ticked up slightly in July. However, compared to this time last year, parent/caretaker enrollment has seen a drastic decline. With the pending Section 1115 demonstration waiver in the hands of the feds, an approval would cause a downward trajectory for childless adult enrollment in the program.
BadgerCare Plus Waiver Update
It's now been exactly a month since the federal comment period on Wisconsin’s proposed Section 1115 Demonstration Waiver officially closed.
The status of that application? "Still Pending."
Recall, in April Wisconsin's Department of Health Services proposed a Waiver to the Centers for Medicare and Medicaid Services (CMS) requesting changes mostly to Wisconsin's childless adult population enrolled in BadgerCare Plus. The Waiver asks the feds to allow drug testing, premiums, work requirements, and additional administrative hoops and hurdles in Wisconsin’s BadgerCare Plus program.
During their comment period, CMS received just shy of 120 comments, a far cry from the almost 1,050 submitted to the Wisconsin Department of Health Services during the first state open comment period, but understandable, since the logistics of commenting to the feds was so very complicated.
There are hints, however, that the feds are looking favorably on state waiver requests. On August 4, CMS approved Florida's Section 1115 demonstration of a "capitated Medicaid Managed Care program and low income pool to support uncompensated care." This was actually an extension of the state's existing waiver that will now carry into 2022. Instead of helping to connect individuals and families to a health coverage system and expanding Medicaid to ensure coverage across all instances of care, Florida will continue its current back-end coverage practices, and allow hospitals to rack up large quantities of uncompensated care, either as bad debt or charity care. The waiver will then allow Florida to infuse $1.5 billion annually to help hospitals alleviate those debts and recover costs on the back end. This, at a time when the current Presidential proposed budget would make deep cuts to Medicaid and undermine the Affordable Care Act, creating more uninsured and by consequence, more uncompensated care.
The approach is backwards and expensive. Providers and patients should be pro-actively assess and optimize their health coverage options long before the bills pile up. Working in advance with patients to connect them to health coverage helps reduce avoidable uncompensated care. This approach promotes front end revenue and reduces ineffective backend collection actions and costs.
But now, we wait to see what CMS will say about Wisconsin's waiver request. If approved, Wisconsin could be implement changes on a fast timeline, likely in about a year.
Voices & Views: Section 1115 Demonstration "Waver"
Attention Advocates: Deadline Maintenence Reminders
Thursday, August 31: is the last 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 August.
Also: Are you applying for BadgerCare Plus and requesting backdating? If you submit an application for BadgerCare Plus before the end of the day August 31, you can request coverage back to May 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.
Did you Lose Coverage in the Past 60 Days?
If you have lost coverage or have had a change in income (or other qualifying event) and therefore qualify for a Special Enrollment Period in the Marketplace, you usually have up to 60 days following the event to enroll in a plan. If you miss that window, you have to wait until the next Open Enrollment Period to apply.
August 15: If you qualify for a Special Enrollment Period and would like coverage to begin August 1st, you will need to pick a plan by August 15. The rule, generally, is that coverage is effective the first day of the following month if a plan is selected between the 1st and 15th of the prior month. The plan is effective the first day of the second following month if you selected a plan between the 16th and last day of the month.
Small Businesses: If you are planning to enroll in the SHOP Marketplace for 2017, your coverage can start in September if you enroll before the Tuesday, August 15 deadline!
The SHOP Marketplace is open year-round for small businesses with 1 to 50 employees. Visit HealthCare.gov/Small-Business to enroll in quality health insurance through the SHOP Marketplace.
Wisconsin Coverage Connections Featured Resource: Deadline Maintenance Fact Sheet
Every month, there are critical deadlines to pay attention to when filing for public benefits programs and Marketplace insurance applications. Do you know what these critical deadlines are?
Utilize the Deadline Maintenance Fact Sheet. The fact sheet covers critical deadlines and timely tips for preservation of application dates when you're running out of time at the end of the month.
Feel free to print and distribute the fact sheet to your network!
Wisconsin Coverage Connections is a collaborative project of Northwest Wisconsin CEP, ABC for Health, Inc., ABC for Rural Health, Inc., Workforce Resource, Inc., Workforce Connections, Inc. and CESAs #4, 10, 11 & 12. The overall project goals are to increase enrollment and retention in BadgerCare Plus for Wisconsin children and parents; increase effectiveness of outreach activities; improve access to health care coverage and services for the underserved; and improve the health of our community.
The project serves a targeted 27-county service area. Individuals working with families in other parts of the state may call to learn about resources closer to their region.
Hosted on the HealthWatch Wisconsin website is the "3 Steps Resource Library" page, with a growing library and downloadable resources. This is YOUR place to learn or refresh your understanding of health coverage and program rules. Enjoy our fun approach to learning the basics of BadgerCare Plus – we call it our "3 Steps to Health Care Coverage!" We discuss how you, and other professionals assisting families, can help families Apply, Use, and Keep BadgerCare Plus!
Watch This: Short Term Insurance
In this week’s featured video, Brynne looks at the almost unnoticed letter sent by 14 Senators to the US Department of Health and Human Services, asking them to open up the time limits on "short term insurance." How did it go unnoticed? It’s all in the timing. Senators drafted and sent this letter while the nation focused on the high drama over "repeal and replace." Why would opening up short term insurance be bad? Brynne explains:
"Conversations on Health Equity" Video Series
A National Institute on Minority Health and Health Equity grantee, The Health Policy Research Consortium (HPRC), produced a 3-part video series exploring health equity--what it is, how the term differs from disparity, and what health disparity research is--especially within the realm of minority health--happening at the various HPRC institutional partners.
Bookmark It! Early Childhood Inclusion: Tip Sheets
The Wisconsin Department of Children and Families administers the YoungStar child care quality rating and improvement system. The program strives to improve the quality of care for Wisconsin's youngest children.
YoungStar hopes to improve child care throughout Wisconsin is by: giving parents the meaningful information they need to make informed child care decisions for their children—at home and away from home. The program creates financial incentives that encourage providers to deliver better services for children, and much more. YoungStar created and provided some tip sheets in order to assist people in developing policies and practices that support the inclusion of all children.
These tip sheets range from laws, challenging behaviors, and to program strategies. Check the tip sheets for yourself.
CYSHCN Corner: Implications of Cures Act for Special Needs Trusts
3 C's for CYSHCN: "Competency, Capacity, & Coordination"
Ask a Good Question...
How does the 21st Century Cures Act impact special needs trusts?
Get a Good Answer
Since 1993, the Special Needs Trust (SNT) has been a much relied upon tool to enable individuals with disabilities to hold assets without losing eligibility for public benefit programs like Supplemental Security Income (SSI) and Medicaid. Assets in a special needs trust can be used to supplement public benefits and purchase items or services beyond the basic needs that public assistance programs are intended to provide. Federal law allows for SNTs to be funded by third parties, typically by a gift or trust provisions in a will, or to be funded partially or completely by assets of the individual beneficiary. The self-funded, or "first party" SNT option can be useful to avoid unintended consequences of lump sum payments from sources like direct inheritances or lawsuit settlements.
Unfortunately, the 1993 law, as written, imposed an unnecessary obstacle to the ability of individuals to establish their own trusts using their own assets. The law required a third party - either a spouse, parent, or grantparent, or a court of law any SNT funded in whole or in part with assets of the beneficiary. That left persons with disabilities who were perfectly capable of managing their own finances in the position of needing a third party to establish their own Special Needs Trust. Individuals without an approved third party needed to petition the court to help establish a trust. Advocates have criticized this puzzling omission from the text of the law for infringing on the independence of competent persons with disabilities and placing legal speedbumps in the way of what should be a straightforward process.
In December, 2016, with the passage of the 21st Century Cures Act, the federal legislature finally succeeded in correcting this oversight in drafting and amending the law to allow individuals to establish and fund their own SNTs with no third party involvement. As explained by the Centers for Medicare and Medicaid Services in a recent letter to state program directors, "This means that a trust established on or after December 13, 2016, by an individual with a disability under age 65 for his or her own benefit can qualify as a special needs trust, conferring the same benefits as a special needs trust set up by a parent, grandparent, legal guardian or court." State programs should update Medicaid program rules to reflect the changed law in the near future.
HealthWatch Wisconsin Coalition Corner
Interested in Joining a Coalition in Your Area?
CLICK HERE to learn more about meetings of a HealthWatch Coalition in your region of the state.
As the health coverage landscape is changing around us, we have heard many people express their interest in getting more involved in the effort to make sure families and children get and stay connected to appropriate health care and coverage.
ABC for Health Inc. and our HealthWatch Wisconsin-Wisconsin project have an exciting new opportunity to help individuals and agencies start their very own HealthWatch Coalition.
In the coming months, HealthWatch Wisconsin will prepare a Request for Proposals, and will solicit applications for individuals or groups interested in starting their own HealthWatch Coalition. We will ultimately fund up to 2 new HealthWatch Coalitions in 2017, supporting their network development needs as they become the local incubators for enrollment and access to coverage conversations. New Coalitions or existing local committees interested in focusing their work on access to health care and coverage issues are encouraged to apply at that time.
We want to include YOUR part of the state! Right now, we have Coalitions in the following counties: Chippewa, Dane, Eau Claire, Milwaukee, Pierce, Polk, and Tri-County (Winnebago, Outagamie, & Calumet Counties).
Watch your inbox in the coming weeks for more information on this exciting opportunity to get involved!
Headlines & Memos
Featured Headlines / Continuation of Past Articles
Health Insurers Get More Time to Calculate Increases for 2018 | NY Times
Study Says Trump Moves Trigger Health Premium Jumps for 2018 | AP News
Trump's Sabotage of the Healthcare System Could Backfire | The Hill
Health 'Navigators' Brace for Decision on Their Funding | Wall Street Journal
CBO to Release Analysis of Ending Key ObamaCare Insurer Payments | The Hill
Next Steps on Healthcare Reform | Manatt
Illinois Names 6 Insurers to Take Part in Overhauled Medicaid Managed Care | Chicago Tribune
A Medicaid Patient Lost the Care He'd Received for 20 Years. 3 Months Later, He was Dead. | Des Moines Register
Widowed Early, A Cancer Doctor Writes About the Harm of Medical Debt | NPR
UI Med Students Oppose Efforts to Repeal Affordable Care Act | Des Moines Register
New State Law on Dental Hygienists Could Be a 'Game Changer' in Improving Access to Basic Care | Journal Sentinel
Study: Medicaid Expansion Helped Reduce Reliance on Federal Income Assistance | UW School of Medicaid and Public Health
Molina to Cut Costs, Eliminate 1,500 Jobs Following Big Loss | Bloomberg
NEW! ACCESS Handbook, published July 10, 2017 in Release 17-02
NEW! FoodShare Handbook, published July 10, 2017 Release 17-01
Medicaid Eligibility Handbook, published May 5, 2017 in Release 17-02
BadgerCare Plus Eligibility Handbook, published May 5, 2017 in Release 17-02
Wisconsin Funeral and Cemetery Aids Program Manual Release 17-01
Department of Health Services (DHS) Announces the Organizations to Provide Family Care and IRIS Services in Dane County. View the entire news release.
Disability Determination Will No Longer Be Required for Children Applying for the Children's Long-Term Support Waiver Program https://www.dhs.wisconsin.gov/dhcaa/memos/17-27.pdf
Marketplace Handbook, published July 19
Administrator's Memo 14-04, 2015 IM Consortia Administrative Allocation, has been published to the DHS website
17-38: Retaining Eligibility for a Child Reaching the Age of 13
17-37: Asset Testing for Child Care
17-36: Updates to Wisconsin Shares "Hardship" Policy and Procedures
17-35: Change in Policy for Gap Filling Eligibility Determinations
2017-24: Cancellation of the Personal Independent Assessment Program
2017-23: Ambulatory Surgical Center Access Payments Discontinued for Fiscal Year 2017
2017-22: Clarifications to BadgerCare Plus and Medicaid SSI Managed Care Provider Appeal Policy
2017-21: Changes to Billing Policy for Serial Casting for Therapy Providers
2017-20: Family Care and IRS Expansion
17-06: Enhanced Federal Funding for Qualifying IM Activities
17-04: 2017 IM Agency FoodShare ABAWD Supplemental Funding Allocation
17-03: 2017 Affordable Care Act (ACA) Funding
Other ForwardHealth Updates:
"Starting August 5, 2017, the Wisconsin Department of Health Services (DHS) is streamlining the process for Medicaid divestment penalty periods for long-term care benefits that includes institutional Medicaid and Home and Community-Based Waivers. The CARES eligibility system will be enhanced to align with existing Medicaid divestment policy to automate a manual process. New correspondence will now notify applicants and members if their long-term care benefits are affected by a divestment penalty period."