Advocates Seek DHS Help in Understanding the Decline

There have been a couple of big surprises in the recent data relating to BadgerCare. One is the much greater-than-anticipated increase in the enrollment of adults without dependent children. (Read more here.) The other is that the number of kids covered by BadgerCare has been decreasing, at a time when the budget bill assumed there would be a large increase.

A new WCCF fact sheet shows the BadgerCare enrollment trends since last September (and since the beginning of 2014), which are broken out for different categories of coverage and income levels. Here are two of the key findings relating to coverage of children:

• The number of children over the poverty level who are enrolled in BadgerCare and Transitional Medicaid (TMA) has dropped by more than 22,000 (12.5%) since September of last year.
• That decline has been partially offset by an increase of almost 13,500 children below the poverty level, yielding a net loss of more than 8,600 kids in BadgerCare and Transitional Medicaid.

Those trends are very surprising because the biennial budget bill assumed that there would be a net increase of about 37,000 children in BadgerCare by June 2015, thanks to indirect effects of the Affordable Care Act. In many other states, those indirect effects have increased enrollment of kids in Medicaid and the Children’s Health Insurance Program (CHIP). According to data in an enrollment report released by HHS a few weeks ago, among the 34 states that had reported monthly enrollment figures from January 2014 to May 2014, the total number of children participating in Medicaid or CHIP increased by 2.2% during that period.

It’s not completely clear why there has been a large decline in BadgerCare participation among Wisconsin children over the poverty level. Keep in mind that the budget bill left eligibility for kids largely unchanged, thanks to the fact that federal law requires states to maintain their current eligibility and cost-sharing standards for children until 2019. (The only significant change for children’s eligibility in Wisconsin was the elimination of the option for families above 300% of FPL to purchase unsubsidized BadgerCare coverage, which affected about 3,500 children.) In addition, children who are eligible for BadgerCare are not eligible for subsidized private plans through the new insurance Marketplace.

Perhaps the most likely explanation for the drop in BadgerCare coverage among children is simply that many of the parents who lost their eligibility haven’t been renewing coverage for their children, which is an outcome that some health care advocates feared might occur. However, the data currently available to the general public isn’t sufficient to answer whether or to what extent that has been an important factor in driving the enrollment trends. And the current statistics don’t tell us how many of the children losing BadgerCare coverage are now in private insurance plans and how many are uninsured. (Read more about some of the other unanswered questions in this WCCF blog post: No Welcome Mat Effect for Kids in Wisconsin.)

Wisconsin’s health care providers, advocates and policymakers need to get a better handle on why BadgerCare coverage of children in our state has been falling at a time when we thought it would increase substantially. Toward that end, WCCF sent a letter to DHS seeking their assistance and posing a number of questions relating to data sources that could shed light on why the current enrollment of children in BadgerCare is far lower than anticipated.

We look forward to working with DHS and others to try to understand why BadgerCare and Transitional Medicaid enrollment of children has declined, and to be sure that our state is moving forward, not backward, in reducing the number of uninsured children.

by Jon Peacock

Photo by Bethlehem Lutheran Church released under a Creative Commons No Derivatives license.