Advocates Seek DHS Help in Understanding What’s Causing a BadgerCare Decline

The BadgerCare changes that Wisconsin put into effect this year have had a surprising and worrisome effect.  Over the last 9 months, the total number of children in BadgerCare and Transitional Medicaid has been falling, at a time when budget experts expected a significant increase in the number of kids in BadgerCare.  WCCF has written to the Secretary of Wisconsin’s Department of Health Services (DHS) seeking the department’s assistance in analyzing data that will shed some light on the unexpected decline in BadgerCare participation among children.

A new WCCF fact sheet shows the BadgerCare enrollment trends since last September (and since the beginning of 2014), which are broken out for different categories of coverage and income levels.  Here are a few of the key findings:

• Since September of last year, the number of children over the poverty level who are enrolled in BadgerCare and Transitional Medicaid (TMA) has dropped by more than 22,000 (12.5%).
• That decline has been partially offset by an increase of almost 13,500 children below the poverty level, yielding a net loss of more than 8,600 kids in BadgerCare and Transitional Medicaid.
• The number of parents in BadgerCare and TMA who are above the poverty level has fallen by more than 71,800 since September, but an increase among parents below the poverty level brings the net change to a decrease of 57,333 parents.

The decline in kids’ coverage in Wisconsin is surprising because Medicaid and Children’s Health Insurance Program (CHIP) participation among children has increased in most other states, and budget experts in Wisconsin had expected an enrollment increase in our state as well.  In fact, the biennial budget bill assumed that there would be a net increase of about 37,000 children in BadgerCare by June 2015.  According to data in a Medicaid and CHIP eligibility and enrollment report released by CMS a few weeks ago, among the 34 states that reported monthly enrollment figures from January 2014 to May 2014, the total number of children participating in Medicaid or CHIP increased by 2.2% during that period.

The increased enrollment results from what is sometimes referred to as the “welcome mat” effect – which occurs when parents sign up children who were already-eligible for Medicaid or CHIP.  That often happens when increased publicity generates more applications for coverage, parents gain access to coverage, or policy changes remove barriers to initiating and successfully completing applications.  Many aspects of the Affordable Care Act encourage and facilitate applications, which is why the budget bill assumed a big jump in BadgerCare enrollment among already-eligible children.

Although the “welcome mat” effect has occurred this year in other states, in Wisconsin the increased enrollment among children below the poverty level has been outweighed by the loss of coverage for children above the poverty level.   That is an unanticipated result, because few people expected that Wisconsin’s policy changes – which for the most part just affect adults – would cause a very sharp reduction among kids above the poverty level.

The Wisconsin figures relating to children’s coverage raise many questions about what is happening to the kids who lost coverage.  For example:

• How many of the children who have dropped off BadgerCare and Transitional Medicaid are now insured via the Marketplace?  Among the rest, how many have other private coverage and how many are uninsured?
• To what extent did changes in income and household definitions cause some parents and children who had been above the poverty level to drop below it?
• Among the children who have lost BadgerCare coverage, what percentage failed to renew their coverage (when they came up for an annual renewal), versus those who are found to be ineligible prior to an annual review?
• Do these trends and other DHS data indicate that Wisconsin needs to improve the renewal process?
• Is the data a reflection of the fact that Wisconsin didn’t spend any money on advertising to promote the ACA?   Alternatively, do the enrollment figures indicate that we need to do a better job of ensuring that parents who lost their BadgerCare eligibility understand that their children are probably still eligible?

Wisconsin’s health care providers, advocates and policymakers need to get a better handle on why BadgerCare coverage of children in our state has declined at a time when we thought it would increase substantially.  Toward that end, WCCF sent a letter to DHS seeking their assistance in finding data that will shed light on why the current enrollment of children in BadgerCare is far lower than anticipated.

We look forward to working with DHS and others to try to understand why BadgerCare and Transitional Medicaid enrollment of children has declined, and to be sure that our state is moving forward, not backward, in reducing the number of uninsured children.

Jon Peacock