ACA In Wisconsin: Leaving BadgerCare For The Marketplace

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ACA In Wisconsin: Leaving BadgerCare For The Marketplace

Premiere Date: 
November 8, 2013

Frederica Freyberg reports on some BadgerCare recipients who will move to the exchanges.

 

Episode Transcript: 

Frederica Freyberg:

But first, confusion reigns, confusion over the new federal health care law and over Wisconsin's new Medicaid changes, changes that leave tens of thousands of people moving off BadgerCare, with the expectation of moving into the health care marketplace. Many of these people are feverishly trying to figure out their options as deadlines approach, even without a fully functioning website and still-changing rules at the state level.  

Becky McElhaney:

I just was blindsided by Nathaniel being taken off of BadgerCare.

Frederica Freyberg:

Becky McElhaney received a letter from the state that her two children, including her 14-year-old disabled son, could be losing BadgerCare coverage because of eligibility changes. She says calls to her county Medicaid office in Wausau confirmed they'd be dropped as of next year.

Becky McElhaney:

I think it's horrible. I mean, we need that help in this family due to the fact that his therapies are very, very expensive.

Frederica Freyberg:

McElhaney was among more than 90,000 people in Wisconsin that received this type of letter from the state in September. Kathleen Goff got the same letter in Kenosha.

Kathleen Goff:

I was disappointed that I was going to be taken off. But I was hopeful that I could find another policy through Obamacare, I'm hopeful that I can, that’s as good as BadgerCare is.

Frederica Freyberg:

The letter said this, “Due to changes in state law, adult members with household income above 100% of the Federal Poverty Level and children with household income above 300% FPL will no longer be eligible for BadgerCare Plus. You or someone in your household may be above these limits.” The letters told people to apply for insurance through the health care marketplace, but that hasn't been easy.

Kathleen Goff:

It always gives me this, “Your account couldn't be created at this time.”

Frederica Freyberg:

The deputy secretary of the Department of Health Services explains the BadgerCare changes.

Kevin Moore:

As part of Governor Walker's 2013-'15 state budget, he initiated an entitlement reform plan to really create a Medicaid program for individuals that are truly in poverty. And also to take advantage of the fact that, with the changes in the Affordable Care Act, that people will have access to affordable health insurance through the exchanges.

Frederica Freyberg:

In McElhaney’s situation, her son, with autism, and her daughter were covered under BadgerCare. She was covered under the state's high risk insurance plan, or HIRSP, because she had previously been denied insurance due to a chronic medical condition. The Affordable Care Act prohibits such denial and so the state program is ending. A complicated case that got more complicated when she couldn't access the healthcare.gov website and took to the phone.

Becky McElhaney:

Right, but can you give me any plan information right now? I need-- you know, I need-- I've been waiting and I'd like to know if you can give me any numbers or plan information about what I'm going to be looking at.

Frederica Freyberg:

Consumer health care advocates say it's crazy out there.  

Bobby Peterson:

We're getting calls. I'm talking to people who are confused, uncertain about whether this is going to affect them or not yet. They're getting letters. They realize that change is coming, and I think, you know, some have tried the marketplace and not been able to get in. So it's a situation where it hasn't reached the panic point yet, at least people that have called us, but I think people are very concerned.

Frederica Freyberg:

According to the state health department, new letters will be going out at the end of this month confirming for BadgerCare recipients whether or not they're definitely out of the plan.

Kathleen Goff:

You're kind of in limbo and you don't know, you know, what is your future, what-- as far as health care.

Frederica Freyberg:

Just this week, McElhaney learned that because of new changes in how child support income is counted, her kids will be eligible for BadgerCare after all. It's a roller coaster, and still leaves her own insurance to consider.

Becky McElhaney:

I have to make sure that I have planning in for my, you know, financial ability to purchase these plans.

Frederica Freyberg:

McElhaney says she pays $544 in monthly premiums for the state high risk plan, plus deductibles and drug co-pays totaling, she says, about $10,600 a year. Bypassing the website and going directly to a private marketplace insurer, she's found a mid-tier plan putting her premium at about $445 a month after a subsidy, with additional deductibles and co-pays. But under the law it cannot exceed the out-of-pocket maximum of $6350 a year after premiums. So she figures the marketplace plan will cost her about $11,600.

Becky McElhaney:

I was hoping it was going to be affordable. I was really actually very excited because I thought, okay, now we all can get into a big group and we all can help, you know, minimize the risk for everybody.

Frederica Freyberg:

In the end, McElhaney says she's relieved her new plan would only cost $1,000 more next year. The Department of Health Services says its latest count is that 77,000 people will have to move off BadgerCare. But some people will get coverage for the first time. Under new rules, childless adults at 100% of poverty will be taken off of a waiting list and can enroll in Medicaid coverage. Governor Walker did not accept the expansion of Medicaid available to states under the Affordable Care Act.


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