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States Seek Ways to Expand Medicaid Enrollment

Wisconsin enacts major changes to its Medicaid program, and Florida gears up to do so as well.

Officials at the Centers for Medicare and Medicaid Services (CMS) last November approved Wisconsin's new Medicaid health care plan, which will allow every child in the state to receive health care at no or low cost.

BadgerCare Plus, the name of the state's new Medicaid program, combines services from the existing BadgerCare program (Wisconsin's State Children's Health Insurance Program [SCHIP]), Medicaid, and the Healthy Start program to provide health care coverage for all the state's children, including free coverage for children in families earning less than 185 percent of the federal poverty level. The program also will offer health care coverage to pregnant women, certain parents and caretakers, and adults aged 18 to 21 who have left foster care.

"Health care in Wisconsin should be a birthright, not a ticket to bankruptcy," said Gov. Jim Doyle (D). "BadgerCare Plus is simple and will provide health care coverage to more families who need it."

Plan Provisions Described

The combined program does not require copayments for pregnant women, children whose family incomes are below the federal poverty level, or American-Indian children whose family incomes are less than three times the poverty level.

Parents also may enroll in BadgerCare Plus if they earn less than twice the federal poverty level.

In January 2009, BadgerCare Plus will expand to include childless adults under age 65 whose household incomes are up to 200 percent of the poverty level.

Kerry Weems, acting CMS administrator, said Wisconsin received approval for changes to BadgerCare because the new approach focuses on enrolling poor children first, limits SCHIP funding for adults, and strengthens requirements that discourage replacing private insurance coverage with SCHIP.

Wisconsin's plan "shows how CMS and states can work together to ensure that children in low-income families have access to health insurance," Weems said in a written statement.

The state initially proposed expanding the plan's coverage to 300 percent of the federal poverty level, or $61,950 for a family of four, according to CMS. However, the state lowered the coverage proposal to 250 percent of the federal poverty level to meet CMS guidelines to prevent so-called "crowd out" of children whose parents move them from private health insurance programs into a cheaper public program. The new program requires families that previously had access to employer-provided health insurance to submit to a longer waiting period before signing up for BadgerCare Plus.

In Fiscal 2006, 56,627 children in low-income families were served by the program; Wisconsin officials estimated that the BadgerCare expansion will allow 7,600 more children to enroll. The state also estimated that about 92 percent of children with family incomes below 200 percent of the federal poverty level already have some form of health insurance.

Florida Responds to Report

Gov. Charlie Crist (R) of Florida and State Supreme Court Chief Justice Fred Lewis called for a major overhaul of the state's mental health system in November 2007 to better address the needs of severely mentally ill individuals.

Crist embraced the findings of a 170-page report released by Lewis that lays out an ambitious plan to help mentally ill individuals who end up in jails and prisons because they haven't received treatment. The plan, they said, will not only help people with mental illness but will also save money through reduced incarceration and improved public protection.

The report, created at the request of the state Supreme Court, called for using Florida Medicaid funds (now spent on mental health treatment for prisoners deemed incompetent to stand trial) to target individuals with "acute and chronic mental illness" for intensive community-based treatment and prevent their arrest.

The aim is to focus on a very small group of people who are costing the state huge sums of money by recycling through the criminal justice system, according to supporters of the proposal.

To launch, the proposal needs about $20 million in general revenue, and its ongoing costs could be covered through Medicaid funds. It could save $48 million now spent on forensic mental health beds for prisoners deemed unfit to face trial.

The state currently spends $250 million a year on 1,700 beds for inmates with mental illness, with a growth rate that forecasts spending of $500 million annually by 2015.

The proposal came after the state Department of Children and Families found itself overwhelmed by the needs of people with mental illness and unable to get inmates into treatment beds within the 15 days required by state law. Eventually the Florida Supreme Court directed a mental health subcommittee of state judges to study the issue and seek solutions.

However, the push to revamp the state's approach to people with mental illness comes during one of the worst economic downturns in Florida in more than a decade. Crist said the budget situation would not, however, keep him from pushing for changes in the mental health system.

Information on BadgerCare Plus is posted at <www.badgercareplus.org>. Information on the Florida Supreme Court report is posted at <http://home.fmhi.usf.edu/common/file/News/44/17.pdf>.

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