IN THE STATES: Simplify, Simplify, Simplify in Wisconsin

When it comes to health reform at a state level, the state that gets the most attention is usually Massachusetts. But other states, such as Vermont, Hawaii, and recently, Wisconsin, are starting to get recognition for their innovations. Different states have different priorities and strategies to accomplish the goals of reform. While Massachusetts, for example, focused on expanding coverage with an individual mandate to purchase health insurance, Wisconsin started simplifying and building on existing public health programs to expand coverage, says a new report.

Produced by the Robert Wood Johnson Foundation and the State Health Access Data Assistance Center (SHADAC), "Wisconsin's BadgerCare Plus Coverage Expansion and Simplification: Early Data on Program Impact," outlines Wisconsin's strategies for reform and provides a preliminary estimate of the state's success.

Simplification was a big deal to Wisconsin reformers. Before Wisconsin's new program, BadgerCare Plus, the state had several different health programs with a bunch of fragmented eligibility requirements -- which was confusing for both members of the public seeking care and officials trying to administer the programs. The inefficient system was also expensive to maintain. BadgerCare Plus combined resources from already existing programs -- SCHIP (called BadgerCare in the state), Medicaid, and Healthy Start. BadgerCare Plus extended eligibility guidelines and simplified the enrollment process, in hope of getting more people to join the consolidated, simplified program.

As we've noted before, having a program in place doesn't mean it's going to be utilized. Often, some kind of outreach campaign is needed to inform people the program exists, explain who is eligible for it, and encourage people to make use of it. And once they're in the program, the deluge of paperwork can discourage continued enrollment. Wisconsin simplified this process by auto-enrolling about 40,000 eligible people in the old programs (like SCHIP) into BadgerCare Plus at the program's inception. Wisconsin also offers an online enrollment option called ACCESS, which explains eligibility requirements and allows people to register online. According to the report, almost 40 percent of BadgerCare Plus applications have come through this online portal.

Expanding coverage is a primary goal of health reformers in Wisconsin. They set their target at 98 percent of the population, but specifically wanted to target children, parents, and other caretaker adults. By consolidating multiple programs, reformers are better able to reach the goal of providing seamless coverage. BadgerCare Plus removed income eligibility limits for children under 19 years old, pregnant mothers, and youth exiting out-of-home care. Previously, pregnant mothers could get care through Medicaid and Healthy Start only if they were below 185 percent of the Federal Poverty Level. Children could get coverage through SCHIP if they were below 185 percent FPL -- now all children and pregnant mothers can get the coverage they need through BadgerCare Plus.

The BadgerCare Plus program is relatively new -- started in February of 2008 -- so researchers are still trying to determine the stability of enrollment in the program. (At what rate are people entering, exiting, or re-enrolling after a time lapse?) But preliminary findings show the program has been pretty successful. Though the new program offered coverage to all income levels, reformers were glad to see enrollment expanded significantly among low-income children and their adult caretakers. And the program is expanding still -- in June 2009, Wisconsin launched the BadgerCare Core Plan to provide coverage to low-income childless adults.

The report pulls out the key strategies that made Wisconsin's program successful, including administrative simplification, auto-enrollment, targeting kids and families as a whole to expand coverage, expanding income eligibility limits, and aggressive community outreach. Though its early, Wisconsin is a good strategic role model for efficient, effective coverage expansion.