Wisconsin children can stay covered under Medicaid for a year thanks to federal policy change

Kids who qualify for BadgerCare Plus, other programs will be able to maintain coverage for a year, even if family income changes

Dr. John Porter examines Connor Russell, 8, during an office visit.
Dr. John Porter examines Connor Russell, 8, during an office visit Tuesday, March 31, 2015, in Richardson, Texas. LM Otero/AP Photo

Wisconsin children will now be able to keep their health insurance through Medicaid programs for a year even if their family’s income changes.

The federally-directed policy change means kids who qualify for BadgerCare Plus or other Medicaid programs will maintain their coverage for 12 months, regardless of whether their family’s eligibility changes.

Bill Hanna, Medicaid director at the state Department of Health Services, said continuous coverage for all Medicaid members during the COVID-19 pandemic caused the rate of uninsured children in the United States to fall to unprecedented levels. He said that led federal lawmakers to approve the 12-month coverage for kids at the end of 2022.

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“We know that there’s churn in Medicaid, especially when you look pre-pandemic, with families and kids coming on Medicaid, going off Medicaid,” he said. “Continuous coverage improves health for these kids. It ensures that they’re getting their well-child visits, they’re getting their vaccines and immunizations, and there isn’t a disruption in service.”

The policy change comes as Wisconsin works through restarting annual renewals for Medicaid, a year-long process referred to as Unwinding that started in June.

Data from the state Department of Health Services shows that as of November, just over 12 percent of all Medicaid recipients in the state had their coverage ended. Prior to the start of Unwinding, total enrollment hit an all-time high in May at 1.68 million members.

Around 12 percent of total children in the BadgerCare Plus program had their coverage end between June and November, with around 540,000 children in the state enrolled at the end of that month. That’s 68,000 fewer kids than the total in April but still 93,000 more children than the average total enrollment before the pandemic.

A pediatrician examines a newborn baby in her clinic.
In this Tuesday, Aug. 13, 2019, photo, Dr. Jasmine Saavedra, a pediatrician at Esperanza Health Centers whose parents emigrated from Mexico in the 1980s, examines Alondra Marquez, a newborn baby in her clinic in Chicago. Amr Alfiky/AP Photo

Children may still qualify for Medicaid coverage, even when adults do not

Around 30 percent of Medicaid members in each of the first three months of Unwinding did not complete the renewal process, according to DHS data.

Hanna said officials would like to see that percentage decrease, but the agency never expected to have all members reapply for coverage.

“There are people who know they are no longer eligible,” he said. “We had people who were losing their jobs in early 2020, restaurants were closing, and so they appropriately applied for Medicaid. It’s now 2024, our economy is doing pretty well, unemployment is pretty low, there’s no doubt some portion of that population now has a job and has insurance.”

But Hanna encouraged all parents to still go through the renewal process to see if they can maintain coverage for their children. He said the income threshold is different for children, and parents may still be able to get help for their kids even if they’re no longer eligible.

Last fall, DHS changed the way they were processing renewals after federal officials found an error was inappropriately disenrolling children and other members.

The previous administrative renewal system — which continues coverage automatically for eligible members instead of having them reapply — did not approve some members who qualified for Medicaid at the individual level because of the eligibility of someone else in their household. State officials said in September up to 4,000 people would have their coverage reinstated after identifying the error.

Updating the system increased the rate of administrative renewals from 8 percent this summer to more than 27 percent in December, according to DHS data.

Justin Rivas, program director for the Milwaukee Enrollment Network, said the change takes the burden off of Medicaid members, especially those who started coverage during the pandemic and may be unfamiliar with the renewal process. He said it’s also been a help to the agencies processing renewals across the state by decreasing their workload.

“That will translate to members who do their renewals having better and more timely experiences, and then ultimately completing renewals and retaining coverage as well,” he said.

Rivas said this efficiency will be especially important as the number of people scheduled to renew each month increases in 2024 during the final months of Unwinding.

“Can we keep achieving the same renewal submission, completion and retention of coverage rates given those increased volumes, and not have too much of an accumulation? That is what’s on our radar,” he said.

Children's Hospital of Wisconsin
Gretchen Brown/WPR

State, local leaders say communication is top priority as renewals increase

Hanna said DHS has been working to ramp up operations to keep up with the increasing renewals, including hiring temporary staff and approving overtime hours. He said the fix to the administrative renewal system will go a long way toward helping the state complete Unwinding. He also said the state remains focused on making sure members know when it’s their time to renew.

“We’ve been doing this for six months and the messaging gets old,” he said. “So we’re going to have to be creative about how we continue to bring this to the forefront.”

Some local partners say the new ability for members to renew up to 90 days late has also made a difference in preventing widespread lapses in insurance coverage.

“It gives us more time for us to get to some of these families,” said Jacqueline Whelan, vice president of quality and analytics at insurance Chorus Community Health Plan, an affiliate of Children’s Wisconsin that offers health insurance plans through BadgerCare Plus and the federal health insurance Marketplace.

Whelan said she thinks the biggest takeaway from Unwinding in 2023 is the need for all the organizations that are involved with Medicaid programs to help make sure members know when it’s their time to renew.

“We recognized that there’s kind of the Swiss cheese effect that happens,” she said. “DHS has contact information, we may have more current contact information, and then we can partner with some of our health care providers, who are often seeing these families more frequently and may have better ways to reach them.”

Whelan said her organization has been closely monitoring how long it takes for people who had their Medicaid coverage lapse to get back into the program. She said many of the people who miss their renewal deadline are finding out when they go to a hospital or clinic, an issue made more complicated in recent months by the uptick in ER and urgent care visits related to RSV, COVID-19 and other respiratory viruses.

“We’re trying to better understand that window of time and how we can support families so that we don’t have a 60- or a 90-day lapse in Medicaid coverage, which is difficult for the family or the payer and for the provider,” she said, noting that Children’s Wisconsin has also extended their billing and claims periods to try to allow families to renew their coverage.