Application for Health Insurance on the Marketplace Released

The application forms for individuals and families to apply for health insurance benefits have been published.  The Centers for Medicare and Medicaid Services (CMS) released the final applications this week after receiving public input.  These forms will be found at www.healthcare.gov on October 1, 2013 when individuals and families can start applying for benefits.  Those benefits will begin January 1, 2014.

CMS released three application forms: one for individuals, one for individuals who are not looking for financial assistance, and one for families.  The applications were shortened in length so the ones for individuals are three pages plus appendices, and the family application is six pages plus appendices.  The application can be completed online, by phone (through a call center) or printed and mailed in.  We don’t know if all three applications will be displayed online or if only one will be displayed and then modified based on the type of applicant.

The opening page of the application packet specifies what the application is for, who can use it, how it can be accessed, what is needed to apply and why that information is needed, what happens next, and how to get help with the application.

The applicant is then asked to complete a variety of questions relating to their household demographics, including residency information, employment, income and any access to insurance they currently have.  One of the appendices request specifics about the applicant’s access to health insurance and requires information on their employer and benefit plan.

After the application is completed, it must be printed, signed and sent in for processing.  The applicant is informed that they will then be contacted in 1-2 weeks for further instructions.  We are not yet sure what, if any, next steps the applicant will be required to take next or how this application will interface with the state’s ACCESS database, which is where individuals in Wisconsin go now to apply for Medicaid benefits.  Both state and federal officials have maintained that this will be a streamlined and consumer-friendly process.

The application packet references a call center (whose number is not yet public) and the www.healthcare.gov website which applicants can access for assistance or additional information.  Locally, advocates and community-based organizations will likely be helping individuals with the application process.   If you are working with uninsured individuals or for those who are interested in learning more about healthcare reform and its provisions, healthcare.gov is a great place to start.  As always, CKF can be contacted to provide clarification and answer questions as well.

The CMS forms can be viewed here:  chttp://cciio.cms.gov/resources/other/index.html#hie

 

Part-time Workers and the Affordable Care Act

(photo courtesy of Michael S. Williamson/The Washington Post)

Consumer Reports recently published an article by Nancy Metcalf responding to the question “Will health reform help part-time workers get insurance?”  Here’s a summary of her response:

Though figuring out their access to insurance may not be as simple and straightforward as it is for a full-time employee, part-time or seasonal employees will have access insurance one way or the other, through their employer or through the Marketplace.  Here’s how employers will decide their employee’s eligibility for their insurance: The employer chooses a measurement period (three months to one year) to identify the average number of hours worked by the employee.  If the employee averages 30+ hours per week during that period, he/she will be eligible for the employer-sponsored insurance (ESI).  If the employee averages less than 30 hours/week, he/she will be referred to the Marketplace to access coverage.  The employee will have that coverage for the designated measurement period (three months to one year). After that initial measurement period, the employer will repeat the same process to re-evaluate the employee’s average hours for the next measurement period.  Depending upon the average hours worked, the employee may maintain their current coverage or have to switch.

Here’s an example:

Employer ABC defines the first measurement period from January through June of 2013.  During that time, Shondra averages well over 30 hours a week and is therefore eligible for ABC’s insurance.  During the second measurement period, July through December, Shondra averages only 27 hours per week.  The employer will notify Shondra she is no longer eligible for the ESI, and she will then have to access the Marketplace to shop for a new plan.  Though Shondra may be eligible for tax subsidies to purchase new insurance, the plan’s cost and coverage may be different than the one offered through her employer.

The above example demonstrates that this process may get confusing for part-time employees. Metcalf advises individuals who worry they may be in this situation to connect with their employer and discuss the details.  Covering Kids & Families can also be contacted to provide more information on this issue and others relating to the implementation of the Affordable Care Act by emailing info@ckfwi.org.

What’s Next for Gov. Walker’s Budget Proposal for BadgerCare+

Earlier this year, Governor Walker announced his 2013-2015 proposed budget which included changes to the BadgerCare+ program.  The proposed changes to adult eligibility have been the focus of recent news.  Under the proposal, beginning in 2014:

1.)   Adults without dependent children with income up to 100% of the federal poverty level (FPL) ($11,490/year for one person) will become newly eligible for Medicaid.

2.)   Adults with income between 100-200% FPL currently on BadgerCare+ will no longer be eligible.

We have recently learned of a few additional BadgerCare+ provisions in the budget proposal that we wanted to share.  If Wisconsin receives federal approval, and the budget is passed as is, beginning in 2014:

3.)   Premiums will apply to children in families with income at and above 150% FPL (approximately $27,000/year for a family of three).  Currently premiums are for children above 200% FPL (approximately $39,000/year for a family of three).

4.)   If a family does not pay their premiums, children will be restricted from re-enrolling in benefits for 12 months.  It is currently a 6-month restriction.

5.)   Children above 300% FPL will no longer be eligible for BadgerCare+.

The budget is still a proposal and must go through a process in order to become law.  As mentioned, some of these provisions will also require the approval of the Federal government. Currently the proposal is being reviewed by the legislature’s Joint Finance Committee. This committee may then choose to open up the review to include hearings around the state for public input. Below is a brief timeline of the expected process before any changes are signed into law:

This month: The Joint Finance Committee (JFC) hears details from the Department of Health Services on specifics of the Governor Walker’s proposed budget.

April: JFC will hold hearings throughout the state to garner public input.  The JFC then makes any recommendations for changes or amendments to the proposed budget and votes on the new version.

Spring: The Senate and Assembly vote on the passage of this new version.

June: The Governor can make final adjustments to the budget and then signs it into law.

Covering Kids & Families will provide updates if and when public hearings are scheduled throughout the state.  Those with opinions on the proposed budget are encouraged to provide their input at these hearings or by contacting their legislators.

UPDATE: JFC STATEWIDE PUBLIC HEARING SCHEDULE

04/04 (10:00 a.m. – 6:00 p.m.) Greendale High School Auditorium, 6801 Southway, Greendale, WI

04/08 (10:00 a.m. – 5:00 p.m.) Lambeau Field, Legends Club Room — 4th Level, Lambeau Field Atrium, 1265 Lombardi Avenue, Green Bay, WI

04/10 (10:00 a.m. – 5:00 p.m.) Kalahari Resort, Suites 2 and 7, 1305 Kalahari Drive,   Wisconsin Dells, WI  54304

04/18 (10:00 a.m. – 5:00 p.m.) Baldwin-Woodville High Shool Auditorium, 1000 13th Avenue, Baldwin, WI

Is Health Reform Responsible for Premium Increases?

Well, depends who you ask.   Just do a Google search on “premiums and health care reform” and a plethora of journal articles, research studies and opinions will claim one of two main arguments:

1.) Obamacare is directly responsible for ongoing increases to consumers’ health care costs.  Premium costs are rising because of the health reform law.

OR

2.) Healthcare costs and premiums have been on the rise for years; Obamacare actually slows the rate of increase and moderates consumer’s spending on health care.  Cost savings will be recognized with time.

Let’s take a closer look at the arguments mentioned above:

Obamacare is directly responsible for ongoing increases to consumers’ health care costs.

A report released this month (March 2013) by the House Committee on Energy and Commerce credits Obamacare as the driving force in premium increases for young adults and middle-income Americans.  The report claims the Affordable Care Act’s (ACA) mandated reforms  have already and will continue to result in higher costs for insurance companies which are in turn passed on to consumers.   The report cites the following ACA reforms/rules directly increase premiums for consumers:  guaranteed issue and community rating, essential health benefits (EHBs), the individual mandate and fees and taxes on plans, drugs and medical devices.

An independent report by Giesla and Carlson (February 2013) reviews the impact of age rating limits established by the ACA, which means older adults can only be charged three times that of a younger adult (currently most states have a ratio of 5:1 or higher).  This report suggests young adults aged 21-29 should expect to pay more for coverage than what they would have without the ACA.

Obamacare slows the rate of increase and moderates consumer’s spending on health care.

Some analysis claims health care costs have been sky-rocketing for years, not just since the ACA was passed in 2010. A KaiserEDU.org background brief on U.S. Healthcare Costs notes that in the United States health care costs increased significantly from 1980 to 2010, with health expenditures nearing $2.6 trillion in 2010, over 10 times the $256 billion spent in 1980. The report states some major factors in cost growth have been the rise in chronic diseases and administrative costs.  The Kaiser brief acknowledges several ACA measures aimed at cost containment including: greater government oversight and regulation of health insurer premiums and practices, increasing competition and price transparency in the sale of insurance policies through Health Insurance Exchanges, payment reforms that aim to reduce payments for treatments and hospitalizations resulting from errors or poor quality of care, and refocusing medical delivery systems to be  patient-centered and improve the coordination and quality of care.

Provisions in the Affordable Care Act used to support the argument that the ACA slows the rate of increase and moderates consumer’s spending on health care include the rate-review provision and the Medical Loss Ratio provision.  The rate-review provision mandates insurance companies must report and justify premium increases over 10%.  Under the Medical Loss Ratio Affordable Care Act provision, insurance companies are required to spend 80% of collected premiums on actual health care. Health and Human Services Secretary Sebelius wrote a blog post about the Medical Loss Ratio provision and how it will save Americans money.

Finally, some proponents of the ACA say that while it may be that the expansion of coverage options and higher quality plans of the ACA increase premiums, the emphasis on quality care, case management, and better service will bring overall health care costs down.

Conclusions

So, is health reform responsible for premium increases?  We’ll end as we started- it depends on who you ask.  Regardless, whatever facts and studies one choses to rely on to support or negate the impact of health care reform, the Affordable Care Act remains the law of the land.   As provisions of the ACA continue to roll out and as conclusions of its impact are advertised, Covering Kids & Families will continue to provide readers with an unbiased review of the information made available.  With specific requests for more information, please email us at info@ckfwi.org.

Walk Through the Health Insurance Marketplace Application Draft

Click to view application.

The Center for Medicaid and Medicare Services (CMS) has developed a draft application for the Federally-run Health Insurance Marketplaces. This will allow stakeholders to review and provide commentary to CMS to help in the production of the next draft and final versions of the application.

CMS has also produced some videos to unveil the online application for the marketplace by walking through the  form and highlighting types of questions families and individuals will need to answer.

The following videos show examples of a single individual and then a family of three applying for coverage:

UPDATE: State Health Officials say pregnant women’s coverage will NOT change under Walker’s plan

The last few blog posts have explored Governor Walker’s proposed budget and its effects on individual’s and family’s eligibility for BadgerCare+.   We updated the blog on Wednesday after news that pregnant women’s eligibility (in addition to adults without dependent children and parents/caretaker relatives) is reduced in the proposed budget.

Well, news came out last night that state officials had no intent to change pregnant women’s eligibility and that this will be clarified further.  Here is the WSJ article.  Wednesday’s blog post was therefore removed.

As ever, we will keep this blog updated with most current information.

Feel free to email us with any questions or further clarification!

What does Governor Walker’s decision to reject Medicaid Expansion funds mean for BadgerCare+?

On February 13th, Governor Walker announced that Wisconsin will not accept federal funds to expand its Medicaid program, BadgerCare+. The Governor instead announced plans for an alternative approach which he says will ensure coverage for many in Wisconsin. Let’s take a look at what this means for individuals covered by BadgerCare+.

Current BadgerCare+ Eligibility Guidelines
Currently the BadgerCare+ program covers children regardless of income, parents and caretaker relatives up to 200% of the federal poverty level ($47,100/year for a family of four) and pregnant women up to 300% of the federal poverty level ($34,470/year). The BadgerCare Core plan provides limited coverage to a select number of non-pregnant, non-disable adults without dependent children whose incomes are below 200% FPL ($22,980/year). The Core program was capped shortly after it was created in 2009. Roughly 21,000 individuals have coverage through the BadgerCare Core program, and 150,000 remain on a waiting list.

Governor Walker’s Proposal
Governor Walker’s proposed alternative plan reduces eligibility guidelines for parents and caretaker relatives and adults without dependent children from 200% to 100% FPL. This also means that adults with incomes below 100%FPL whom were on the waiting list for Core will now have coverage.

Adults (except pregnant women) above 100% FPL will no longer be eligible for BadgerCare+ and would instead be offered to purchase private coverage through the online Marketplace. Individuals with incomes between 100-400%FPL will be eligible for premium tax credits to offset the cost of coverage in the Marketplace which starts this fall under the Affordable Care Act or “ObamaCare”.

Plan Highlights
Under his proposed plan, Governor Walker estimates nearly 225,000 uninsured Wisconsinites will gain coverage. This is encouraging news for the non-pregnant, childless adults under 100%FPL as many have been on the Core waiting list and uninsured for years.

Governor Walker: ““With these Medicaid reforms, we will preserve an essential safety net for our neediest, while protecting our state’s taxpayers from uncertainty…Our plan safeguards Wisconsin taxpayers from unnecessary risk and builds on Wisconsin’s strong track record of providing affordable health care to our people.”

Coverage Concerns of Proposed Plan
There is some concern for other populations affected by the change in BadgerCare+ eligibility. Parents and caretaker relatives moving from BadgerCare+ coverage to private coverage in the Marketplace will likely face higher premiums, co-pays and deductibles for their coverage. Although there will be premium tax credits for families between 100-400%FPL, health care advocates worry that the private insurance will still be unaffordable, causing some of these parents/caretaker relatives to become uninsured.

Additionally, those parents and caretaker relatives transitioning into the Marketplace will now have separate coverage than their children. The difficulty in managing multiple insurance plans and coverage options also presents a concern that some family members may drop coverage.

What Happens Next
Governor Walker’s proposed full budget proposal was released on February 20th.  It now will be reviewed by the Wisconsin Legislature’s Joint Finance Committee and the State Senate and State Assembly before being signed into law.  Some provisions of the budget may also require federal approval before they are enacted.

If Governor Walker’s alternate proposal for Medicaid is approved, eligibility guidelines will change sometime in the future. In addition to the changes that will come with the Governor’s budget, additional options for the uninsured will be available by January 1, 2014 through the Marketplace.  For the time being, eligibility remains as is for the BadgerCare+ program.

Stay tuned for more details, Danielle