About 15,000 Adults who are Affected Will at Least Briefly Retain Coverage in Transitional Medicaid

Don’t be surprised if you start hearing state officials citing lower figures for the number of adults who will lose their BadgerCare coverage at the end of the year. In a sense it’s good news, but it isn’t so much “news’ as an overdue correction in how we describe the effects of the budget bill on adults participating in or applying for BadgerCare.

In the last week or two, DHS has released figures on the number of people who received letters from the department in late September telling them that they are likely to lose their BadgerCare coverage at the end of the year. Here’s the tally of people who got letters:

• 68,567 parents or caretakers who are over the poverty level (and not eligible for Transitional Medicaid);
• 5,283 childless adults over the poverty level;
• 3,622 children over 300% of FPL;
• 1,222 adults in the unsubsidized BadgerCare Basic plan;
• 14,932 parents/caretakers between 100% and 133% of FPL who are in Transitional Medicaid and will start having to pay premiums in January (assuming that part of the waiver is approved);
• 163,808 childless adults on the Core Plan waiting list (about half of whom are expected to be eligible for and enroll in BadgerCare by the end of the biennium on June 30, 2015).

In short, the number of adults expected to lose eligibility for subsidized BadgerCare coverage in January is a little shy of 74,000. That’s considerably below the figure of about 92,000 adults that you may have heard on many occasions from me, DHS and others; but the difference is a bit deceptive.

The primary reason for the lower figure now is that the BadgerCare changes morphed slightly during the budget process.  They changed after federal officials made it clear that Wisconsin wouldn’t be granted a waiver to eliminate Transitional Medical Assistance (TMA) coverage, which is a longstanding part of welfare reform that extends Medicaid eligibility for up to 12 months after someone is lifted above the poverty level by a new job or a raise.

As I explained in a WCCF blog post a couple of months ago, the revised DHS plan is to apply premiums to the nearly 15,000 adults in TMA and between 100% and 138% of FPL – i.e., the Transitional Medicaid participants who aren’t already paying premiums. Retaining TMA is a lot better than eliminating it, but for a couple of reasons it’s less of an improvement than you might guess:

• If Congress doesn’t act soon, the law setting TMA at 12 months will expire in January and the maximum extension of eligibility will revert to just 4 months. 
• Imposing premiums for people in TMA who are close to the poverty level will cause many of them to drop out right away – as we saw when the state began in 2012 to apply premiums to adults in TMA over the poverty level. (Read more here.)

I think there is a second and smaller factor relating to why the new figures from DHS are lower. I believe that participation of adults over 133% of FPL has been dropping faster than expected from the changes initiated in July 2012 (though I need to study the data more carefully to be sure of that).

In examining the latest figures from DHS, keep in mind that this isn’t the last word on the subject. We will find out in December how many people are sent formal notices of the termination of their BadgerCare at the end of the year. Yet even those numbers aren’t the end of the story because those terminations won’t routinely be based on accurate determinations of eligibility, since they won’t reflect all the new ACA rules on determining income and family size. And unless the online federal application process is fixed faerly soon, the people whose eligibility is incorrectly terminated will have little chance of avoiding becoming uninsured in January.

But I digress. For now, let’s take a brief moment to be thankful that the number of adults losing their BadgerCare coverage in January will be a little smaller than we expected earlier this year — even though the extension for people on Transitional Medicaid is likely to be very brief.

Jon Peacock