Program Type: Wisconsin operates a combination CHIP program, called BadgerCare Plus.
Number of Children Covered: In FY2013, 167,292 children were covered by BadgerCare Plus.*
State’s Enhanced Federal Match Rate: For FY2014, the federal match is 71.34%, and for FY2015 it is 70.79%.
*Data from Medicaid and CHIP Payment and Access Commission March 2014 MACStats report.
The Children’s Health Insurance Program (CHIP) was created in 1997 to provide quality health coverage for children under 19 in families that earned too much to qualify for Medicaid but were unable to afford coverage in the private market. Each state has the option to cover its CHIP population under its Medicaid program, design and structure a separate CHIP program, or establish a combination program using both options.
The Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 strengthened the program through increased federal funding, new outreach and enrollment opportunities, mental health parity, the requirement to cover dental care, and other provisions. In 2010, the Affordable Care Act (ACA) extended CHIP funding through federal fiscal year 2015 and required states to maintain Medicaid and CHIP eligibility levels and processes for children through 2019.1
Participation Rate: 90.3% of eligible children in Wisconsin participated in either Medicaid or BadgerCare Plus in 2011, the last year for which we have national data. The national average was 87.2% in 2011.2
Eligibility Levels: States establish CHIP eligibility levels within federal rules. Under the ACA’s maintenance of effort requirement, they must maintain CHIP eligibility levels they had in place when ACA was enacted until September 30, 2019. Beginning in 2014, eligibility levels for CHIP were revised based on Modified Adjusted Gross Income (MAGI).
|Modified Adjusted Gross Income (MAGI) Eligibility Levels for CHIP in Wisconsin (by Age Group) in 2014|
|Ages 0 – 1||Ages 1 – 5||Ages 6 – 18|
|Medicaid Expansion||N/A||N/A||102-151% FPL|
|Separate CHIP Program||N/A||187-301% FPL||152-301% FPL|
Notes: Under ACA, states must cover all children with incomes up to 133% FPL in Medicaid, but if they had been covered in CHIP (Title XXI) prior to 2014, the state still receives the Title XXI match. Eligibility levels do not include the mandatory 5% income disregard. Medicaid expansion program data from CMS staff; separate CHIP program data from CMS eligibility table. Conception to birth coverage is also offered under the CHIP unborn child option up to 300% FPL.
Benefit Package: States that operate Medicaid expansion CHIP programs must follow Medicaid rules, including providing all Medicaid covered benefits to enrolled children. In separate CHIP programs, states have substantial flexibility in designing CHIP benefit packages within broad federal guidelines. In addition to general medical and dental benefits, other benefits offered in Wisconsin’s CHIP program include (but are not necessarily limited to):
Delivery System: BadgerCare Plus and Medicaid use a managed care delivery system.
Premiums & Cost Sharing: Within federal parameters, states can set CHIP program premium and cost sharing levels. In total, any family contribution to the cost of coverage cannot exceed five percent of family income.
|Premiums and Cost Sharing in BadgerCare Plus, 2013|
|Family Income Level||Premiums||Office Visits||Inpatient Services||Prescription Drugs|
|≤200% FPL||None||$0-$3||$3 per day||$1-$3|
Note: MAGI-adjusted income levels for premiums and cost sharing were not available at the time of publication. As of April 2014, benchmark plan coverage ended for children and all CHIP children receive Medicaid benefits and have Medicaid copayment levels, which differ from these amounts.
Efforts to Simplify Enrollment and Renewals: CHIPRA established a five-year incentive program to support state efforts to simplify enrollment and renewal of eligible children in Medicaid and CHIP.3 From FY2009 – FY2013, Wisconsin received a total of $87,739,927 in incentive payments.4
|Enrollment and Renewal Strategies Implemented in Wisconsin, as of December 2013|
|Elimination of in-person interview*||
|Use of presumptive eligibility||
|Elimination of asset test*||
|Use of 12-month continuous eligibility|
|Use of joint application and renewal forms*||
|Use of express lane eligibility||
*ACA requires states to implement this strategy beginning January 2014. For definitions of strategies in this chart, see the Centers for Medicare and Medicaid Services December 2009 State Health Official letter.
Other Program Characteristics: Below are some other key program characteristics of BadgerCare Plus.
|Require a waiting period?5||Yes, 3 months only if >150% FPL|
|Offer a buy-in option?6||No 7|
|Cover dependents of public employees?8||No|
|Cover lawfully residing children without a five-year waiting period?9||No|
Quality Measures: States may report on a “core set” of quality measures for children. Wisconsin reported on 2 measures for federal fiscal year 2012.
2 Genevieve Kenney et al., Medicaid/CHIP Participation Rates Among Children: An Update. September 2013. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407769
4 InsureKidsNow.gov. “CHIPRA Performance Bonuses: A History (FY 2009 – FY 2013).” http://www.insurekidsnow.gov/professionals/eligibility/pb-2013-chart.pdf