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As of May, the Medicaid health program BadgerCare Plus has already tripled the number of new patients that state officials expected to sign up for the coverage by June 2009. In its first five months, the health plan for families added more enrollees than the state has done in any similar period in at least a decade, officials said. That influx is adding more stress to a Medicaid budget that state officials acknowledge is already in the red by $78 million.
Since mid-January, BadgerCare Plus for families has brought in more than 4,000 new enrollees in Dane County alone, the bulk of them children.
Most surprising, officials said, more than eight out of 10 of the state residents signed up for BadgerCare Plus since that date were needy enough that they already qualified for Medicaid coverage even before this new state program expanded access to higher-income residents.
“The remarkable thing there is that the vast majority of that increase has been among (lower-income) people,” said Jon Peacock, research director at the Wisconsin Council on Children and Families. “Most people assumed that most of the growth would be” among those with higher incomes.
Benefits children
That fact amounts to a boon for uninsured children and a 15.6 percent increase in the state’s Medicaid rolls for low-income families, increasing the total from 484,000 to 559,400. But it will be a mixed blessing for taxpayers and the already strapped state budget, as state officials acknowledged it will likely raise costs significantly for the program expansion, which they previously said could be covered without new money from state taxpayers.
BadgerCare Plus, a program championed by Democratic Gov. Jim Doyle, essentially makes Medicaid coverage available to all uninsured children in Wisconsin, except for those whose parents already have access to adequate coverage through an employer.
It eliminated the previous income ceiling of $42,400 for a family of four to qualify for health insurance for children. The program also raised income limits for parents and pregnant women under Medicaid and made it easier for farmers and the self-employed who are parents to qualify for coverage.
Enrollment soared
By June 2009, the state had expected to sign up 26,000 more children and adults as a result of the BadgerCare Plus changes, said Jason Helgerson, Medicaid director for the state Department of Health and Family Services.
But as of last month, the state has already signed up 75,500, he said. That number easily surpassed the 39,200 the state added in the first five months of the BadgerCare program, the last big state Medicaid expansion, which began in July 1999.
The weakening national economy could push the program’s growth even higher in the future, as increases in Medicaid enrollment tend to lag behind economic downturns, Helgerson said.
“It’s been amazing the amount of growth we’ve seen and obviously there was pent-up demand for the program,” he said. “It’s going to cost more than we had anticipated. How much more it’s too early to tell.”
Helgerson said the state had originally expected $47.7 million in added federal and state costs with the current expansion of BadgerCare Plus for the two-year budget. State health department officials had expected to cover more than the state’s share of expansion costs through increased use of health management organizations, or HMOs, other administrative savings and monthly premiums and other charges to enrollees in the program, he said.
Over the next several months, state officials will need to see how much in services new enrollees in the program are using to get a handle on the expected increase in costs, Helgerson said. About two out of three of the new enrollees are children, who are generally the cheapest patients to cover because they use relatively little medical services, he said.
$78 million shortfall
But the state’s $3.98 billion Medicaid budget is already projected to be about $78 million, or about 2 percent short for the two-year period ending in June 2009, Helgerson said. That shortfall, which doesn’t include any extra BadgerCare Plus costs, is due in large part to $60 million in transfers from the overall Medicaid fund being used to help balance the state’s strained budget, he said.
“Obviously it’s still a challenge but we see it as a manageable challenge,” said Helgerson, who didn’t expect state taxpayers would need to kick in more money to make up the difference.
Rep. Kitty Rhoades, R-Hudson, co-chairwoman of the Legislature’s budget committee, said any transfers from the fund would have originated with the Doyle administration, not lawmakers. She said that it was the administration that had said this round of the BadgerCare Plus expansion wouldn’t cost any more money.
Easier enrollment
The reasons for the unexpectedly high enrollment rates include changes to the program to streamline the enrollment process and make it easier for families to show they qualify, Helgerson said.
But the biggest factor is the simplicity of the message that most uninsured children now qualify for Medicaid coverage in Wisconsin, enabling the agency to reach many families who never before realized they qualified, he said.
The success reaching those lower-income families helps justify the expansion, which faced some past criticism for attempting to increase eligibility to those with higher incomes when it wasn’t fully reaching those who already qualified, Helgerson said.
“Those are some of the neediest kids, kids who have some of the least ability to access health services,” Helgerson said of the new enrollees.
Caseloads increasing
Among the latest recipients is 2-week-old Bjorn Burnson, whose mother Tish Blaser, 29, brought him in for a routine check-up last week at the East Side clinic of Access Community Health Centers. Without BadgerCare Plus, it would have been difficult to pay for the preventive visit, said Blaser, a waitress who is taking time off to be with her newborn.
“It just puts a strain on a new family,” Blaser said of health-care costs and the difficulties of getting insurance.
Access, which serves uninsured and low-income clients, is now signing up more families for BadgerCare Plus each month, because of factors that include an increased effort by Access, the expanded income eligibility limits and probably the souring economy, development officer Tammy Quall said.
“People that have been struggling all along may be struggling more” now, Quall said.
Lynn Green, director of the Dane County Department of Human Services, said the increase in enrollments from BadgerCare Plus had likely contributed to an increase in caseloads for her staff for that program and others such as food stamps.
“We are overwhelmed. There’s no question, some of our caseloads are up to 600 now” per caseworker, Green said. “We continue to get no more assistance in the way of staffing from the state.”
Helgerson acknowledged short-term problems for counties but said state officials continue to hope that the changes to simplify the enrollment process would make it easier for counties to handle their caseloads in the long term.
Program expansion set for January
The state is moving forward with a program to provide health coverage to low-income childless adults starting in January.
This further expansion of the BadgerCare Plus Medicaid program hasn’t yet been affected by the state’s budget troubles, said Jason Helgerson, Medicaid director for the state Department of Health and Family Services.
The program still needs approval by federal officials, and state health department officials still need to come up with the money to start, which wasn’t included in the state budget passed last year. Last week, U.S. Reps. Tammy Baldwin, D-Madison, and Paul Ryan, R-Janesville, led a group of nine members of the state’s congressional delegation in calling for federal approval of the expansion.
Jason Stein is a reporter for the Wisconsin State Journal in Madison.
