May 3, 2012 12:08 pm Posted by

Good Afternoon,


We wanted to take this opportunity to touch base with you regarding the Department’s Medicaid Savings Initiative.


As many of you are aware, the Department has been negotiating with the Centers for Medicare and Medicaid Services about changes to Wisconsin’s BadgerCare Plus Program.


It was announced on Friday, April 27th that the Department and CMS have come to agreement on some of the changes.  Children age 18 and under are not affected by these changes.

The federally approved program changes will only affect income-eligible non-pregnant, non-disabled adults above 133% of the Federal Poverty Level ($25,390 for a household size of three) and do not apply to children. 


Beginning July 1, 2012, there will be changes to:


 *   Monthly premiums (depending on income) – some members will be required to pay premiums and those who already do may see increases to their existing premiums; individuals who do not pay their premium will not be eligible for 12 months


 *   The rules regarding access to employer-sponsored health insurance – individuals described who have access to affordable health insurance through their employer will be asked to utilize that coverage rather than the publicly funded option


 *   Retroactive eligibility – members described above will no longer be eligible for three months of backdated eligibility


If any of these changes affect members, they will receive a separate notice of these changes and their impact (i.e. paying a premium or the new premium amount).  The letter with information specific to the member’s case will be mailed in mid-June.


Now that we have reached federal approval of these policy changes, DHS will be working to make the necessary systems updates (ACCESS and CARES) to support the new policies.  Currently, we are working to determine how these changes specifically impact each of our members. Due to the time that it will take to make the systems enhancements to support the newly approved policies, we won’t know until mid-June how these changes will specifically affect members.


Beginning May 1, 2012, members will receive a notice letting them know about the BadgerCare Plus policy changes that will be effective on July 1, 2012.  All households above 100% FPL will be receiving a letter as the policy changes affect members above 133% FPL.  We wanted to give members advanced notice of the new rules, including changes to monthly premiums that could mean that they will now have a monthly premium or that their monthly premium will increase. We will not know until mid-June, once the systems updates are in place, how the new rules will specifically impact each household.


More information, including a copy of the letter and fact sheet that were sent to members is available at badgercareplus.org/updates.htm


Please note, beginning July 1, 2012, there are a couple of changes to policies that will expand the income guidelines for retroactive eligibility (backdating) and access to affordable employer sponsored health insurance for kids.


Retroactive Eligibility (Backdating)

Beginning July 1, 2012,

• Infants less than 1 year old with household income at or below 300% of the FPL may qualify for retroactive eligibility

• Children ages 1 though 5 (up to age 6) with household income at or below 185% of the FPL may qualify for retroactive eligibility.

NOTE: Children ages 6 through 18 will remain eligible for three months of backdated eligibility, if their income is at or below 150% of the FPL.


Access to affordable employer sponsored health insurance Children’s access to employer sponsored insurance will continue to be based on whether or not the employer pays at least 80% the premium or the access is to a State Employee’s health care plan. However, effective July 1, 2012, the following groups of children will no longer be subject to the crowd out policy:

• Infants less than 1 year old with household income between 150 – 300% of the FPL will no longer be subject to the access and coverage requirements;

• Children ages 1 though 5 (up to age 6) with household income between 150 -185% of the FPL will no longer be subject to the access and coverage requirements.


DHS plans to hold some partner meetings, including a web cast to discuss these changes with community partners.  An email will be sent out in early May with the dates and locations.


Thank you for your continued assistance.  Please don’t hesitate to let me know if you have any questions.



Claire Smith

Senior Communications Specialist

Bureau of Enrollment Policy and Systems

Divsion of Health Care Access and Accountability

Wisconsin Department of Health Services

1 West Wilson Street

P.O. Box 309

Madison, WI 53701



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