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Wednesday, June 6, 2012

State Sued for Not Enrolling BadgerCare Participants

More than 130,000 childless adults waiting for coverage

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Two Milwaukee women and Legal Action of Wisconsin are suing the state Department of Health Services (DHS) for failing to enroll the women in the BadgerCare Plus Core program.

The Plus Core program, which serves low-income childless adults with no other health insurance options, has an enrollment cap of 48,500 individuals.

Yet in April, only 25,800 people were enrolled.

About five times that number—131,000 individuals—were on the waiting list.

Two of those individuals—Teresa Charles and Susan Wagner, of Milwaukee—are eligible for BadgerCare Plus Core but have been on the waiting list for more than two years.

Charles has a chronic lung condition and no health insurance.

Wagner suffers from a seizure disorder and has no health insurance.

Charles and Wagner contend that DHS is violating state and federal laws by failing to enroll them in the program within 60 days.

In May, state Rep. Jon Richards (D-Milwaukee) and state Rep. Tamara Grigsby (D-Milwaukee) had asked the federal government to look into Wisconsin's potentially illegal waiting list for the BadgerCare Plus Core program.

On Tuesday, Richards agreed with the lawsuit's plaintiffs that the state must enroll qualified individuals within 60 days until it reaches the enrollment cap.

“That's the law,” Richards said. “Unfortunately, the Walker administration has specifically not enrolled people in that program even though there is room available to provide insurance under that program.”

Both Charles and Wagner would have been eligible for the General Assistance Medical Program (GAMP), a precursor to the Plus Core plan in Milwaukee County and elsewhere. GAMP didn't have a waiting list at the time it was folded into BadgerCare in 2009.

“That's the frustrating part,” Richards said. “We eliminated the program that they would have relied on and they [the Walker administration] are not letting them in the program we created to take its place.”

Paying for BadgerCare

BadgerCare Plus Core, like other Medicaid programs, is funded by both the state and federal government.

The federal government pays 60%, while the state picks up 40% of the cost. The federal share is money that would have been sent to hospitals that provide a substantial share of medical care to uninsured individuals. The state share comes from a fee levied on hospitals as well, although it is not specifically earmarked for BadgerCare. The thought was that instead of paying for uncompensated care at hospitals, the federal and state governments would provide funds for insurance for low-income Wisconsinites.

DHS spokeswoman Stephanie Smiley couldn't comment specifically on the lawsuit. But she wrote in an email to the Shepherd that the federal government requires the program to be “budget neutral” and that the state would exceed the amount budgeted for the program if it took people off the waiting list.

“The department is not in a position to open enrollment to the Core plan because we are currently tasked with finding additional savings to the Medicaid program,” Smiley wrote.

But an analysis by Jon Peacock, research director for the Wisconsin Council on Children and Families (WCCF), indicates that the state likely has enough funds to enroll more people than the 25,800 individuals currently covered.

Peacock found that the budget bill assumed that the enrollment freeze would be lifted and individuals would be taken off the waiting list. At budget time, it was assumed that 43,000 childless adults could be covered per month with a cost to the state of $57.8 million annually. Estimates have fluctuated based on updated data, Peacock wrote, but he calculated that the state could afford to serve an estimated 34,400 individuals—roughly 9,000 more people than are currently enrolled in BadgerCare Plus Core.

“When DHS imposed the moratorium on additional enrollment, state officials said they would start taking people off the waiting list once enrollment fell to the point where average monthly spending had declined to the cap set by the waiver agreement,” Peacock wrote in a paper to be released publicly this week. “The state reached that point more than a year ago, but the Walker administration has yet to lift the moratorium on Core Plan enrollment.”

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