Many proposals for federal health reform include two key elements: a Medicaid expansion to include all people below a certain income level; and some form of subsidy to make private insurance coverage more affordable for individuals and families.1 These subsidies would begin where Medicaid eligibility ends, and phase out as income increases. Wisconsin’s BadgerCare Plus program, while it does not include private insurance options, does contain many elements of a Medicaid-plus-subsidies model (Medicaid, CHIP, a CHIP buy-in option, and a coverage option for childless adults). While many questions remain around clarifying how Medicaid expansions and subsidy programs would be administered, BadgerCare Plus can shed some light on how a state might manage a range of health insurance options that combine Medicaid with other insurance products.
Concerned about the impact of the rising costs of health insurance on families, businesses, and local governments, Wisconsin designed a health insurance program to offer affordable coverage to more of its citizens. In February 2008, the BadgerCare Plus Medicaid and Children’s Health Insurance Program (CHIP) expansion in Wisconsin began. Since then, BadgerCare Plus has been successful in increasing enrollment, not only of newly eligible groups but also of those who were previously eligible for Medicaid.2 Using the flexibility to vary benefit packages provided in the federal Deficit Reduction Act of 2005 (DRA), BadgerCare Plus extends commerciallike health insurance coverage to all children in Wisconsin, as well as to pregnant women, youth leaving foster care, and self-employed parents.3 In conjunction with these coverage expansions, Wisconsin implemented eligibility and enrollment simplifications to facilitate participation in the BadgerCare Plus program.
This issue brief highlights key aspects of BadgerCare Plus in Wisconsin that may be helpful for other states as they seek to create integrated health insurance systems to extend coverage to more of their citizens. The accompanying fact sheets provide additional details on individual features of the BadgerCare Plus program design.
1The Senate Health, Education, Labor and Pensions Committee drafted legislation that includes subsidies to individuals up to 500% FPL and a small business credit. The Senate Finance Committee is discussing individual and small business health insurance tax credits. Committees in the House of
Representatives have proposed individual subsidies up to 400% FPL and a small business tax credit.
2From the implementation of BadgerCare Plus on February 1, 2008 through the end of June 2009, 158,254 beneficiaries enrolled.
3A further expansion to childless adults began in Milwaukee County in January 2009. This expansion is paid for using only state funds.