A health care safety net
The woman had no health insurance and therefore no ability to see a doctor outside the emergency room, where she would rack up an expensive medical bill.
“Her only option was just not going,” said Furseth, executive director of Community Action, which runs the shelter in Darien Township.
Furseth said income limitations too often force people to forego seeing doctors when they are sick, which means their health problems only get worse and more expensive.
Enter BadgerCare Plus, a new program to ensure 98 percent of state residents, including all children, have access to affordable health care. The program, included in the state budget to be signed by the governor today, will take effect Feb. 1, 2008.
Q: What is BadgerCare Plus?
A: BadgerCare Plus is an initiative to give every child in Wisconsin access to affordable, comprehensive health care, regardless of family income. Although the focus is on children, the program is available to other groups, too. It merges old programs with the new program to provide coverage to the most residents.
“It’s the most significant reform and expansion of the health care safety net since the Medicaid program was created in the late ’60s,” said Jason Helgerson, state Medicaid director.
Q: Whom is the plan meant for?
A: “It’s really targeted to people who, right now, don’t have access to employer-sponsored health insurance,” Helgerson said.
Q: What about families who already have health insurance?
A: BadgerCare Plus is meant to bridge the gap between the approximately 90 percent of people in Wisconsin who have health insurance and the 10 percent who don’t.
“If mom and dad have access (to health insurance), usually in most cases through their job, this program isn’t meant for them,” Helgerson said. “This is for those who just don’t have health insurance.”
Q: But anyone can buy into the plan, right?
A: All parents, regardless of income, can get health insurance for their children. Others who meet certain income requirements can also get coverage through BadgerCare Plus.
“If they need it, they can get it,” Helgerson said.
Q: Who’s eligible for the plan?
A: -- All children.
-- Pregnant women with incomes up to 300 percent of the federal poverty level (FPL).
-- Parents and caretaker relatives with incomes up to 200 percent of FPL.
-- Caretaker relatives with incomes up to 200 percent of FPL.
-- Parents with children in foster care with incomes up to 200 percent of FPL.
-- Youth (ages 18 through 20) aging out of foster care.
-- Farmers and other self-employed parents with incomes up to 200 percent of FPL, contingent on depreciation calculations.
-- Childless adults with incomes up to 200 percent of FPL.
Q: What’s it cost?
A: For kids, premiums start when a family is at 200 percent of the federal poverty level. Those below that level don’t pay anything. For kids, premiums start at $10 a month and can range up to $100, with a sliding scale based on income. For parents, premiums start when a family is at 150 percent of the federal poverty level. Co-pays are nominal for lower-income people, from 50 cents to $3 for some services. Preventive care and basic office visits are free. For people with higher incomes, co-pays are in line with what they would pay for a private insurer.
Q: What kind of coverage do people get?
A: There are two plans under BadgerCare Plus:
-- The Standard Plan is the current Medicaid benefit package and is for children, parents and caretaker relatives, youths aging out of foster care and pregnant women with incomes up to 200 percent of FPL.
-- The Benchmark Plan is modeled after the most popular private health insurance plan in the state and is meant for children and pregnant women with incomes above 200 percent of FPL.
“Any health care need a doctor says is medically necessary, we cover,” Helgerson said.
Q: What are the benefits of enrolling?
A: “Having health insurance is not a luxury. It’s a necessity in life,” Helgerson said. “You put yourself and your family at significant risk if you go without health insurance. Some people may think they don’t need it now ... but you can’t predict what’ll happen tomorrow.”
Q: How is this different from BadgerCare?
A: BadgerCare Plus is a merger of three programs available for low-income working families, BadgerCare, Family Medicaid and HealthyStart, which combined serve about 500,000 people in Wisconsin.
“This really builds upon the program, expands it and simplifies it,” Helgerson said.
BadgerCare Plus means less and simpler paperwork and eligibility requirements, among other changes.