Wisconsin’s BadgerCare Plus Coverage Expansion: Early Evaluation Results

Wisconsin’s BadgerCare Plus Coverage Expansion: Early Evaluation Results APPAM 2009 Lindsey Leininger State of WI Collaborators: Milda Aksamitauskas, Linda McCart Principal Investigators: Tom DeLeire, Thomas R.Oliver Project Director: Donna Friedsam

Wisconsin’s BadgerCare Plus (BC+) Ongoing reform effort launched in 2/2008 Overarching goal of preliminary initiatives: provide universal access to coverage for children Three specific components: Eligibility expansion Administrative simplification Marketing and outreach efforts

Crowd-Out Provisions Altered Under BadgerCare : Individuals with access to “affordable” health insurance were ineligible Individual responsible for ESI verification Under BC+: People in families <150% FPL exempted Employer responsible for ESI verification

Creative Use of Systems Enhanced and promoted online application Effort to “auto-convert” unenrolled individuals who were made newly eligible under BC+ rules For example, children with siblings already on assistance

Outreach Held community meetings throughout state prior to program launch Mini-grants to 31 organizations (up to $25,000 per organization), paying “finders fee” of $50 per approved BC+ application Use of more than 200 community partner organizations to help sign up families

Evaluation Quantitative component Estimate changes in aggregate program enrollment and in socioeconomic composition of program enrollees Assess the impacts of the auto-conversion process Estimate program impacts on exits and “churning” Qualitative component In-depth, semi-structured interviews with key informants from local and state government, health care associations and advocacy groups Review of health policy literature, official documents and media reports

Quantitative Data Sources Monthly WI administrative panel data Study period: 1/2007 through 5/2009 Contains income and demographic information Current Population Survey Note: Conducted reliability test of CPS denominators against estimates derived from Wisconsin’s Family Health Survey (FHS) and the American Community Survey (ACS).

Key Income Cutoffs < 150% of FPL: BC+ crowd out provisions do not apply < 185% of FPL: Eligible for BC/Medicaid/Healthy Start pre-expansion < 200% of FPL: BC+ Standard plan (limited cost-sharing) > 200% of FPL: BC+ Benchmark plan (premiums and cost sharing), parents/caretakers are ineligible > 300% of FPL: Kid’s premium = full cost

Study Populations All children Stratified by FPL (<150% FPL, 150-200% FPL, 200-300% FPL, 300% + FPL) Low-income (<200% FPL) parents Stratified by FPL poor (<150% FPL), near-poor (150-200% FPL)

Enrollments Relative to Population Estimates: Children Child All <150 150-200 200-300 300+ Urban Rural Dec-07 24% 84% 19% 0.3% 0.0% 21% 36% May-09 29% 94% 37% 5% 0.4% 25% 42% Change 5% 10% 18% 4% 0.4% 5% 6%

Change in Initial Enrollment per Uninsured Population: Children

Parent Enrollment by FPL Dec-07 May-09 Change % of change All 176,686 237,779 61,093 100% <150 166,051 210,213 44,162 72% 150-200 10,113 23,435 13,322 22% 200+ 390 4,131 3,741 6%

Change in Enrollment per Uninsured Population: Parents

Enrollments Relative to Population Estimates: Parents

Churning: 6 Months Churning = % of enrollees in a given month who exit and re-enter the program within a 6 month window

Who Are the Auto-Converts? All Kids Parents Auto-enrolled in Feb. 2008 41,148 17,132 24,016 Of these, what % had a family member enrolled in Jan 08? Any family member 92% 87% 95% Parent/Spouse 26% 41% 15% Sibling/Child 80% 61% 94% Previously Enrolled (2007) 62% 71% 56%

Auto-Converts vs. Other New Enrollees

Summary of Findings Large enrollment increases among parents and kids Structural break at program launch with a continuing upward trend Numbers higher than projected Strong belief that program has been successful; however, officials concerned about budget problems Majority of new enrollees came from the already eligible Stakeholders credit the success of outreach efforts and branding as “all-kids” coverage

Summary, Cont’d Exits and churning: Program exits increased during transition period; are leveling off at a lower rate than the pre-period But churning does not yet appear significantly affected Next up: estimating more sophisticated statistical models of exit and churning Belief among officials and advocates that substantial numbers of eligible members will not remain in the program if required to pay premiums Auto-conversion enrollment Effective way to enroll newly eligible children; exits among non-premium payers comparable to those of other enrollees

Implications for Reformers Eligibility expansions coupled with administrative simplification and aggressive outreach can facilitate take-up, even in the absence of a mandate Autoenrollment is a promising policy option for enrolling newly eligible poor populations

Next Steps Immediate: Estimate crowd-out using a variety of administrative and survey data sources Future: Evaluate impact of the next phase of the BC+ reforms New program for adults without dependent children (“Core Plan”)

Wisconsin’s BadgerCare Plus Coverage Expansion: Early Evaluation Results

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Wisconsin’s BadgerCare Plus Coverage Expansion: Early Evaluation Results

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