Medicaid, SCHIP, and Federal Authority⁴

Section 1115 Waiver - In 1999, Wisconsin got approval from CMS to implement the Wisconsin BadgerCare program, a statewide Medicaid expansion that utilized the managed care delivery system to provide health care to both SCHIP and Medicaid beneficiaries while at the same time expanding coverage to new populations. The demonstration extended coverage to c hildren and custodial parents of eligible children with net family incomes through 185 percent FPL. Once a family is eligible, they retain benefits up to 200 percent FPL.

High-Risk Pool  

Wisconsin 's high-risk pool, the Wisconsin Health Insurance Risk Sharing Plan (HIRSP) became operational in 1981 and provides a choice of three benefit coverage options. The pool is financed through policyholder premiums, assessments on insurers, and provider discounts. Premium subsidies are available for qualified low income policyholders. The premium cap is set at 200 percent of the rate that a standard risk would be charged under a policy providing the same coverage deductible. At the end of 2005, just under 19,000 persons were enrolled in the program.

Group Purchasing Arrangements  

In 2003, Wisconsin Governor Jim Doyle (D) signed legislation into law that creates five regional health care purchasing alliances to bring farmers and small businesses into one pool per region. These cooperatives allow groups to directly negotiate with health plans. In 2005, Governor Doyle passed new legislation that removes limits on the number of cooperatives that can be developed in the state. By encouraging the establishment of cooperatives, the hope is that not only will more uninsured individuals access health insurance, but also that competition will increase among carriers and create more options for coverage.

Other

General Assistance Medical Program (GAMP) - The GAMP is a community safety-net system for uninsured residents in Milwaukee County. To be eligible for coverage an individual must be uninsured and have a family income below 125 percent FPL, depending on family size. GAMP covers services such as primary care and clinic services, inpatient and outpatient hospital care. GAMP is funded by state and federal Medicaid revenues as well as Milwaukee County tax levy. In 2004, GAMP provided access to over 30,000 individuals.

	Notes and Sources

Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile.

² Once eligible, family recipients remain eligible for BadgerCare until the family's income exceeds 200 percent FPL.

⁴ The profile only includes Medicaid and SCHIP waivers intended to make comprehensive expansions to the uninsured. At this time, the profiles do not include Family Planning, Pharmacy Plus waivers, or long-term care waivers.

⁵ Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey.