Evaluation of the BadgerCare Medicaid Demonstration
BadgerCare is a public health insurance program developed by the State of Wisconsin
to address the needs of low income families who lack health insurance, and to
assist families in their transition from welfare work. The State received waivers
of Title XIX (Medicaid) and Title XXI (State Child Health Insurance Program
- SCHIP) rules under Section 1115 of the Social Security Act to provide public
health insurance coverage to families not normally eligible for these programs,
and to make other reforms. The key features of BadgerCare are eligibility expansion
(to families with incomes up to 185 percent of the Federal Poverty Level - FPL),
elimination of the asset test for eligibility, family coverage, monthly premiums
for families with incomes above 150 percent of FPL, State subsidy of employer-sponsored
health insurance and additional outreach to encourage qualified families to
participate.
In September 2000, CMS (then HCFA) awarded a contract to RTI International
to evaluate BadgerCare. The following is a summary of findings from the Final
Report, which was received by CMS in December 2003.
Evaluation Highlights:
Lessons Learned: Program Planning: By all accounts, BadgerCare has succeeded
in achieving its main objective of bridging the gap between Medicaid and private
insurance for the working poor. The program’s success is attributed in
part to the collaborative program planning process in which program planners
sought and received input from all key stakeholders. Success is also attributable
to the State’s progressive tradition in health care and the determination
of a handful of policy makers to develop a workable solution.
Lessons Learned: Implementation: State planners credit BadgerCare’s
quick start-up and effective operation to the decision to use the existing Medicaid
infrastructure (including the eligibility determination and health care delivery
systems) and to fine-tune the system later as needed. The collaborations forged
during the program’s planning phase continue to help to bring about the
needed system changes.
State Outreach Efforts Were Successful: BadgerCare enjoys wide name recognition
in the State, attesting to the success of its outreach efforts. The program
is viewed as distinct from Medicaid and thereby has succeeded in reducing welfare
stigma typically associated with public programs.
Implications of Family Coverage: The ability to enroll the entire family
in a single health insurance plan was viewed as desirable by most enrollees
but was not the most critical factor driving their enrollment.
Lessons Learned: Premiums: Most enrollees who paid premiums believed that
they were reasonable in amount, but for a small number of potential enrollees,
premiums were a deterrent to enrollment. Furthermore, we found that premiums
were not a significant factor affecting “churning,” the practice
in which individuals disenroll from the program and then re-enroll again shortly
thereafter.
Improved Continuity of Enrollment: BadgerCare has succeeded in improving
the continuity of enrollment among low-income publicly insured individuals.
Of note is the greater likelihood of continued eligibility and enrollment of
women with Medicaid-covered deliveries who would otherwise be uninsured during
their infant’s first year of life.
Improved Access to Care: BadgerCare enrollees enjoyed equivalent or better
access to medical care as individuals enrolled in employer-sponsored insurance
(ESI) plans and much better access than uninsured, low-income families. Problems
accessing dental care were common among all insurance coverage groups.
Little Evidence of Adverse Selection: No significant differences were seen
in reported health status between BadgerCare adult or child enrollees and those
who were either uninsured or covered by ESI or other insurance. BadgerCare/Medicaid
participants were somewhat more likely to report a physical or mental limitation
than eligible non-participants, however, and participating families were more
likely to have a family member with a special health care need.
ESI Buy-In: Wisconsin’s premium assistance plan has not been successful
in enrolling a significant number of families. Stringent eligibility rules for
families, employers, and health plans and the lack of efforts to promote the
programs to the business community were given as reasons for this failure
Delays in HMO Enrollment: Whereas three-fourths of BadgerCare enrollees are
enrolled in HMOs, the delay in initial enrollment in a plan following BadgerCare
enrollment was sometimes substantial, potentially leading to delays in receiving
routine health care.
Status of Remaining Uninsured: Individuals in the State who remain uninsured
experience substantial unmet health care needs and frequently forego routine
and preventive health care. Many of these individuals are precluded from enrolling
in BadgerCare because of waiting periods or other program eligibility conditions.
Impact of Disenrollment: In three out of four premium-paying families who
disenrolled from BadgerCare, family members experienced periods without health
insurance coverage following disenrollment. These families also reported relatively
higher rates of adults and children in fair to poor health and with greater
unmet health care needs.
Full Report
Evaluation of the BadgerCare
Medicaid Demonstration Final Report (December 2003 .pdf 1,136)
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Last Modified on Thursday, October 28, 2004
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