Legislature Approves New Health Insurance Option for Childless Adults

As the Legislature wrapped up the 2009-10 session last week, the Assembly gave final approval to the BadgerCare Plus Basic Plan (SB 484), which provides an unsubsidized, bare bones health insurance option for low-income childless adults who are on the current BC+ Core Plan waiting list. It will be signed by the Governor soon, and implementation of the new option is expected in the next few months.

The bill was approved in the Assembly last week, by a vote of 50 to 47. The legislature adopted several amendments to the bill, which are described in an April 20 Legislative Council Memo. (Because the bill contains an appropriation – from the premiums, it can be item-vetoed by the Governor, and I won’t be surprised if he uses that authority to undo one or more of the amendments.)

It will be very interesting to see how many people enroll in the new plan during the first few months. My best guess is that it will be a relatively low number since about half the people on the waiting list have no income. Also, for those who do have some income, the $130 per month premium is still a substantial barrier, especially for a bare bones plan with substantial cost-sharing. I suspect BC+ Basic will mostly serve people who recently lost their jobs (or their COBRA coverage) but who have accumulated assets and understand the value of having insurance and protecting those assets.

Yet even if the Basic plan only serves a small fraction of the people on the waiting list, I think that could still be a success story – if it attracts enough healthy people to be a sustainable strategy for the next few years (until states are required in 2014 to expand MA coverage to 133% of the poverty level). The problem in creating a new insurance plan like this is to avoid having a large degree of “adverse selection” that would yield a relatively unhealthy pool of enrollees whose average costs exceed the $130 per month premium. That’s very difficult to pull off, especially when there's no money available to subsidize the plan.

The Legislative Fiscal Bureau summary of the bill briefly discusses that potential problem and outlines the options available for DHS if the actual costs do exceed the premium revenue:
“(a) using federal funds from the HRSA grant to support the plan's benefits; (b) decreasing the scope of benefits offered under the plan; (c) increasing premiums; (d) reducing rates paid to providers; or (e) some combination of these options. No legislation would be required for DHS to implement any of these options …However, all of these options have potential consequences. For instance, increasing premiums or reducing benefits may exacerbate the effects of adverse selection, as the plan's remaining enrollees might be those with disproportionately high health care costs. In addition, using HRSA grant money to support the Basic Plan would reduce the amount of federal funding that would otherwise be available to support Core Plan benefits.”

In short, I think that serving a portion of the waiting list with an unsubsidized insurance plan will be an interesting experiment and an extremely difficult challenge. I have two hopes. First, that legislators and the general public don’t have an unrealistic expectation that BC+ Basic will serve a large percentage of the people on the Core Plan waiting list. Second, that the people it does serve are healthy enough that the new program can indeed be self-sufficient and can help fill a gap in coverage between now and 2014.

But whether BC+ Basic succeeds or becomes a relatively short-lived experiment, I hope policymakers will also explore the new option under the federal health care reform act to extend a benchmark Medicaid benefit to all childless adults up to 133% of the poverty level – as discussed in a recent letter to state officials from the Centers for Medicare and Medicaid Services. That would capture federal matching funds, improve the benefit package, reduce cost-sharing and make a much bigger dent in the current Core Plan waiting list.

NJJN Releases Platform Brief on DMC; Outagamie & Kenosha Counties Highlighted for DMC Work

The National Juvenile Justice Network has just released its policy platform brief on DMC - the fourth in a series of policy platform statements endorsed by the network. Each brief is meant to be a guide for policy-makers, advocates, and others interested in advancing what works in juvenile justice. This one highlights the need for Commitment, Collaboration, and the Collection of Data as three critical themes that should run through DMC efforts. With all the progress being made in evidence-based practice, balanced and restorative justice - amid decreasing juvenile crime rates and the growth of community-based services, reducing DMC may very well be the most important legacy for the current generation of juvenile justice advocates.

Also, Kenosha and Outagamie Counties received attention in the most recent DMC e-news publication, highlighting the efforts that are underway there to systematically reduce DMC an ensure equity at key decision-making points. Cehck it out and sign up to recieve continuing DMC alerts.

JJDPA Reauthorization Inches Forward

Amid all the issues going on in Washington, it was good news that the House Education and Labor Committee held a hearing on April 21 on issues identified in the JJDPA reauthorizaton bill. You can check out the Youth Today report on the hearing. So, while reauthorization poses some problems for compliance in Wisconsin (see the January/February WisKids Journal), overall the fact that the discussion is continuing is positive.

Tax Day Musings

It used to be that we scurried to drop our income taxes in the mail before the April 15th deadline. Now most of us log on to our computers to file taxes instead of standing in line at the Post Office. The result, though, is the same: income taxes are on everybody’s mind on April 15th. Wisconsin will collect more than $6 billion in personal income taxes this year. Where does all that money go?

For every dollar you pay in Wisconsin taxes that goes into the General Fund, by far the biggest share this year – about 41¢ – will go towards supporting K-12 education. Schools in Wisconsin are financed through state aid, local property taxes, federal aid, and other local revenues such as fees.

The state aid to schools helps keep property taxes from being higher than they are now, as does an additional 13¢ will go to county and municipal governments to provide services, and 7¢ that will provide direct property tax relief in the form of credits that appear on your property tax bill. All of the forms of direct and indirect local aid or property tax relief account for 61¢ of every dollar you pay in state income or sales taxes.

Eleven cents of every income tax dollar will support higher education in the form of the University of Wisconsin System, technical colleges, and student grants and aid. (The state funds about one-quarter of UW System operations.) Another 8¢ will go towards corrections costs, with the same amount going to cover Medical Assistance/BadgerCare costs.

With about 88¢ of every dollar of state taxes dedicated to supporting schools and property relief, higher education, corrections, and health care, only about 12¢ is left for other public programs and structures. That last dime and two pennies of every state tax dollar will be spread out over a variety of state programs, such as environmental programs, the state’s judicial system, prescription drug assistance for the elderly, and tax credits such as the Homestead Tax Credit and the Earned Income Tax Credit.

Filing income taxes will never be pleasant. But whether we’re clicking a mouse or licking a stamp to submit our forms, we should remember that state income tax dollars fund essential public services and maintain public structures we’ve taken decades to develop.

A Good Summary of Research on Delinquent Girls

OJJDP has just published a good resource document, Causes and Correlates of Girls' Delinquency, which provides an overview of, and brings the reader up to date on, the research unique to girls' involvement in delinquent behavior. The research is categorized in eight groups, including Biological and Individaul Factors, Family Influences, the Impact of Peers, and Neighborhood Effects. If you've been able to keep up with all the literature on this issue, you may not find anything new - but you will find it in one place with references for further study.

National Crime Victim's Rights Week: April 18-24

Take note that National Crime Victim's Rights Week is coming up next week. While WCCF normally is focusing on offenders, we also know that the "gap" between many youth being offenders and victims isn't always great - many of them have been victims of/exposed to domestic violence, abuse, and other trauma that has impacted their lives. In addition, those of us advocating for developmentally appropriate interventions for youthful offenders need to recognize, as do the offenders themselves, how their behavior can impact those around them - sometimes as a start to helping them earn their way back into their communities.

Celebrate Children Day Challenge Extended for 2 More Days

GREAT NEWS! Generous sponsors of the Celebrate Children Day Giving Challenge have offered to extend the donation deadline to 11:59pm on Friday, April 16th, giving you 2 MORE DAYS to join in! And, in order to help participating organizations (including WCCF) earn the challenge funds, the match is now structured as follows:

--When the total reaches $5,000 in donations, the pool will earn $5,000.
--After that, donations will be matched dollar for dollar up to an additional $10,000.

Please support organizations involved in early childhood by participating in this excelling giving opportunity!

WI Budget Project Launches New Website

Tomorrow is Tax Day, and to mark the occasion WCCF's Wisconsin Budget Project has launched a new website located at www.wisconsinbudgetproject.org featuring, among other things, an excellent Budget Basics Guide and a new quiz to test you knowledge of state tax and spending matters. The Budget Basics Guide covers everything from where the state's revenue comes from to what it gets spend on to how the budget gets created. The quiz poses questions about where Wisconsin ranks among the states on a variety of tax and spending measures.

In addition to the website and the quiz, the Budget Project also released today a new brief titled "How Does Wisconsin Compare in State and Local Spending and Expenditure Growth?" The brief examines how spending in Wisconsin has changed over time, and addresses the question of whether our budget difficulties can be resolved by relying primarily on spending cuts.

THIS IS TODAY!!!
The Celebrate Children Foundation is sponsoring a one-day opportunity to support seven Wisconsin organizations--including the Wisconsin Council on Children and Families--involved in promoting the importance of the first five years in children's development. The first five years of life build the foundation for giving kids the best possible chance to thrive throughout their lives. On April 14, please visit the Celebrate Children Day website and make a one-time contribution to support this important cause.

How it Works
On Wed. April 14 go to the Celebrate Children Day website and make a single contribution. You can help even more by spreading the word via your own social networks.

All money raised will be split equally between seven organizations:

* Wisconsin Early Childhood Association
* Wisconsin Council on Children and Families
* Supporting Families Together Association
* Parents Plus, Inc.
* Wisconsin Alliance for Infant Mental Health
* Partnership for Wisconsin's Economic Success
* Celebrate Children Foundation

Our overall fundraising goal is $100,000. Several generous sponsors have agreed to match a portion of the money raised. If we reach our $100,000 goal, the "match" will add an additional $15,000 to the total.

Thank you for support and for your help in spreading the word about this opportunity to provide much needed resources to our efforts on behalf of young children in Wisconsin. Please help by forwarding this information to others interested in the well-being of young children across the state.

*Donations will be accepted beginning at 8:00 a.m. CST on April 14th, 2010.

New Brief Explores Sales Tax Collection on Online Purchases

WCCF's Wisconsin Budget Project has published a new brief on the issue of sales tax collection on online purchases. Sales tax is due on purchases made by Wisconsin residents, whether the purchase is made in a bricks and mortar store or an online business. However, some large online retailers, such as Amazon.com, do not collect the sales tax due on purchases made by Wisconsin residents. This paper, "Examining Wisconsin's Progress in leveling the Tax System for Retailers," examines the issues surrounding sales tax and online purchases, as well as tools available to compel collection of sales tax.

Celebrate Children Day - April 14, 2010---A 24-Hour Online Giving Challenge

THIS IS TODAY!!!
The Celebrate Children Foundation is sponsoring a one-day opportunity to support seven Wisconsin organizations--including the Wisconsin Council on Children and Families--involved in promoting the importance of the first five years in children's development. The first five years of life build the foundation for giving kids the best possible chance to thrive throughout their lives. On April 14, please visit the Celebrate Children Day website and make a one-time contribution to support this important cause.

How it Works
On Wed. April 14 go to the Celebrate Children Day website and make a single contribution. You can help even more by spreading the word via your own social networks.

All money raised will be split equally between seven organizations:

* Wisconsin Early Childhood Association
* Wisconsin Council on Children and Families
* Supporting Families Together Association
* Parents Plus, Inc.
* Wisconsin Alliance for Infant Mental Health
* Partnership for Wisconsin's Economic Success
* Celebrate Children Foundation

Our overall fundraising goal is $100,000. Several generous sponsors have agreed to match a portion of the money raised. If we reach our $100,000 goal, the "match" will add an additional $15,000 to the total.

Thank you for support and for your help in spreading the word about this opportunity to provide much needed resources to our efforts on behalf of young children in Wisconsin. Please help by forwarding this information to others interested in the well-being of young children across the state.

*Donations will be accepted beginning at 8:00 a.m. CST on April 14th, 2010.

Improvements to BadgerCare Plus May Yield Federal Bonus Funding

The Department of Health Services (DHS) continues to make improvements in the BadgerCare Plus program, taking advantage of opportunities provided by the Children’s Health Insurance Program Reauthorization Act (CHIPRA). The latest change, which was announced by DHS last week, will help expedite the annual renewal process for BadgerCare Plus. It may also enable WI to qualify for extra financial assistance.

States are eligible for CHIPRA bonus funding if they exceed certain targets for increasing Medicaid enrollment of children, and if they meet 5 of 8 CHIPRA standards for improving policies relating enrollment and retention. The bonus is a significant increase in the federal match rate for each Medicaid child above the growth target.

One of the 8 standards is expediting the renewal process by automatically using recent income figures or other relevant information from other state databases. This administrative or “ex parte” renewal approach allows a state to keep eligible kids covered with negligible paperwork.

DHS took initial steps toward meeting that standard in January 2010, when it began allowing online renewal, including use of “pre-populated" forms for people coming up for their annual review. Those forms automatically fill in information needed for renewal if it is accessible in the state’s computer databases. However, federal officials told DHS that making this option available only to people who apply online would not be sufficient to meet this particular standard for bonus funding.

On March 29, DHS issued an Operations Memo (#10-25) that initiates the use of prepopulated forms for people who request mail-in renewal applications. This change appears to be sufficient for WI to meet the administrative renewal standard. If so, it would be the 5th standard WI meets and should make our state eligible for CHIPRA bonus funding in the current federal fiscal year.

We don’t know exactly how much bonus funding WI could potentially receive, and the exact amount will be affected by enrollment changes over the course of the current federal fiscal year (through Sept.); however, the amount is probably on the order of a few million dollars per year. That funding will help the state maintain and continue to strengthen BadgerCare Plus coverage for Wisconsin children.

The administrative reforms are also valuable in themselves, because they make it easier for eligible children to keep the BadgerCare Plus coverage that helps them grow and thrive. And that means parents struggling through the recession get some badly-needed peace of mind and our state spends health dollars more wisely, on prevention instead of expensive ER care for problems that didn’t have to become emergencies.

I have been regularly updating a checklist of options created by CHIPRA to improve access to health care for children. The latest version, updated late last week, describes the standards states can meet to qualify for bonus funding and the status of Wisconsin’s efforts to meet 5 of those standards.

March Job Gains Help Economy, but Don’t Reduce Unemployment Rate

Today’s employment numbers are generally positive, but not all the news is rosy. On the plus side, there was an increase of 162,000 jobs nationally, and almost three-fourths of the increased employment was in the private sector. On the other hand, the unemployment rate was unchanged – holding at 9.7 percent. The latter phenomena seems like a paradox, but is actually quite common during the early stages of an economic recovery, because “discouraged workers” who stop looking for employment during a recession aren’t counted in the unemployment rate. The official ranks of the unemployed grow as those jobless workers begin returning to the workforce and are once again counted as unemployed.

The economic data provide further evidence that the labor market is starting to improve and that the American Recovery and Reinvestment Act enacted in February 2009 is having positive effects. However, we are only just beginning to see a reversal from the net loss of 8.2 million jobs since the recession began in December 2007. (See the chart below from the Center on Budgt and Policy Priorities.)

The stubbornly high unemployment rate reinforces the conclusion that Congress should extend the portions of the Recovery Act providing extra weeks of unemployment insurance and subsidized COBRA health insurance coverage for unemployed workers. Extending those provisions to the end of the year and providing additional fiscal assistance to cash-strapped states are very effective means of stimulating the economy and protecting critical safety net programs. They should be top priorities for Congress when it returns from the current recess.

WCCF Testifies in Support of Returning 17 Year-Olds to Juvenile Court

At a hearing of the Assembly Committee on Corrections and the Courts, WCCF provided testimony in support of AB732 to return 17 year-olds to the juvenile system. The testimony cites six (and there are more) key reasons why this should be done. Others speaking at the hearing included representatives from counties who oppose this particular bill - while in general supporting the policy of returning 17 year-olds to juvenile court, concerns focused on the funding and ensuring that sufficient resources would be allocated so as not to disrupt that good progress that has been made in providing local prevention and early interventin programming. Perhaps the most significant testimony, however, was provided by families harmed by the 1996 change that subjected 17 year olds to adult court. Vicky G.from La Crosse told the story of her son, Kirk, who committed suicide in jail while awaiting proceedings on his adult charge; and Mary H. and her son Ben - Ben ended up in a county Huber facility shortly after turning 17 and was introduced there to drugs and a host of other negative influences. Fortunately, Ben is now on track through the support of his family and a program in Milwaukee - but he will be haunted for a long time by his now-criminal record.

NCCD Supports Returning Wisconsin 17 Year-Olds to Juvenile Court

The National Council on Crime and Delinquency (NCCD) has issued a statement of support for AB732, a bill authored by Rep. Fred Kessler, that would return 17 year-olds to the juvenile system - starting with youth alleged to have committed a misdemeanor. The NCCD statement reflects what we know about the failed policies of treating 17 year-olds as adults as well as the benefits to youth and the community by providing necessary services in the juvenile system.

Health Care Reform Bill Amendments Will Boost Wisconsin’s Share of Federal Financing

The health care reform reconciliation (or “fix it”) bill that was signed by the President on Tuesday improves the bill financially for Wisconsin. Although the final product is much closer to the Senate’s version than the House bill, two changes that were championed by the House will give Wisconsin a larger and fairer share of federal financial support for the health care system.

Medicare payments for hospitals – Hospitals in Wisconsin and a number of other fairly rural states have long been getting significantly lower reimbursement rates for Medicare services than hospitals in many other states, despite producing some of the best health outcomes. Rep. Kind and other members of the Wisconsin delegation worked hard to see to it that the reconciliation bill will help reduce that inequity by making Medicare payments to providers more closely tied to quality outcomes. For example, beginning in 2013, a portion of a hospital’s Medicare payment will be linked to the hospital’s performance on quality measures related to common and high-cost conditions. The new law also directs the Institute for Medicine and the National Academy of Sciences to conduct a study and develop recommendations to level the playing field for states like Wisconsin that have been getting the short end of the current payment system.

Funding for coverage of childless adults – A very important part of the bill is the requirement that states provide Medicaid coverage to all citizens with incomes below 133 percent of the federal poverty level, beginning in 2014. To soften potential opposition from the vast majority of states that don’t currently cover many adults, the bill will initially pay the full cost of insuring newly eligible parents and childless adults, and will continue to pay about 90 percent of those costs on an ongoing basis. However, in Wisconsin and the 10 other states that are now covering childless adults, early versions of the bill would not have increased the federal share of spending on the already eligible adults.

The final compromise addresses that inequitable treatment and is a much better deal for Wisconsin, at least with respect to coverage of childless adults below 133 percent of the poverty level. Beginning in 2014, the federal share of spending for those already enrolled childless adults will jump to 80 percent in Wisconsin, from the current 60 percent, and it will gradually climb to 90 percent in 2020. For newly eligible childless adults, such as those on the BadgerCare Core Plan waiting list, the federal government will fund the full cost from 2014 through 2016, and then that share will gradually decline to 90 percent in 2020. From that year forward, the federal match rate will be 90 percent for all childless adults below 133 percent of poverty, and that will be consistent in all 50 states.

Shorter term assistance for covering childless adults? – Those two improvements for Wisconsin won’t take effect until 2013 and 2014, respectively. However, a provision of the bill that takes effect today (4/1/2010) could bring Wisconsin additional federal aid if the state were to file a Medicaid plan amendment to cover childless adults. For more on that topic, see the April 1 Kaiser Daily Health News. Such an amendment might enable Wisconsin to get federal Medicaid matching funds for childless adults, rather than having to use our disproportionate share hospital (DSH) funding for that purpose. On the other hand, that option might require enhancing the current BadgerCare Plus Core Plan benefit package and making the program an entitlement without a waiting list – at least for childless adults below 133 percent of the poverty level. Although those could be significant challenges, the state should explore the new options to see if the new law would allow the current level of state funding to leverage more federal dollars and eliminate or reduce the Core Plan waiting list.