On February 1, 2008, Wisconsin launched the BadgerCare Plus program, which expanded and simplified eligibility for health coverage in the state (see table). In the first six weeks of the program, more than 71,000 individuals—many of them children and the majority of whom were previously uninsured—were enrolled in the program. This number far exceeded expectations and also surpassed similar efforts by other states. State officials attribute Wisconsin’s success to several factors.
First, Wisconsin has been leading the country in Medicaid administrative simplification. Eligibility rules were made simpler and were standardized across programs. For example, the state reduced the number of earned income disregards and increased the income limit. They also automated verification of employer-sponsored insurance and allowed all individuals under 150 percent of the federal poverty level (FPL) into the program regardless of access to employer-sponsored coverage. The goal was to make the program easy to understand for enrollees and staff.
Second, Wisconsin invested in outreach. They gave $25,000 to 42 agencies within the state to help those agencies build the infrastructure needed to help people apply for the program. Through several program expansions since the early 1990s, Wisconsin has learned that a key to boosting enrollment is to have people in communities who are able to help complete applications. The state also developed an ad campaign, and several key state officials traveled around the state to raise awareness about the program. Calling the coverage expansion for children an “all kids” program also boosted enrollment by letting all families know this program could be for them.
Third, Wisconsin supported and promoted online applications. They made the online application easier and trained community workers around the state to use it. In the first months of the program, online applications have increased from approximately 25 to 50 percent of total applications.
Finally, Wisconsin invested in staff to process applications, particularly in Milwaukee, where delays had been the norm. They developed a new processing center in Milwaukee that is currently able to approve applications and get cards out to enrollees within a week.
The state’s initial projection was that 26,000–27,000 would enroll during the first 12–18 months of the program. In retrospect, state officials note that they undercounted many families who were already in the system, often because a member of the family was already receiving health coverage or other services. The simplified rules enabled the whole family to come into the program through one streamlined application.
Wisconsin is now turning its attention to the childless adult population. They are working with the Centers for Medicare and Medicaid Services to develop a program that will provide health coverage to adults with incomes up to 200 percent FPL.
*Note: There are sliding-scale premiums for kids between 185 and 300 percent FPL and a full-cost buy-in above 300 percent FPL. There are also sliding-scale premiums for adults between 150 and 200 percent FPL.
