RETRO CHANGES TO MEDICAID IN WISCONSIN
MAKE IT MORE DIFFICULT FOR HEALTH CARE FACILITIES
As a part of Wisconsin’s legislation trimming the budget, Wisconsin recently announced
eligibility changes to their Medicaid “BadgerCare Plus” program. These changes affect
the window of opportunity to submit applications and will have a deep impact on all
collected Medicaid revenue for facilities in the state of Wisconsin. Our goal is to assist
you in this process and keep you knowledgeable of the changes that took effect July 1, 2012.
Current Eligibility Policy:
All members of a household with income less than 150% of the Federal Poverty Level
(FPL) can be eligible up to 3 months prior to the application month if income was less
than 150% of the FPL in all of the back dated months and the household met all other
financial and non-financial requirements.
New Retroactive Eligibility Policy (effective July 1):
Parents and Caretakers
BadgerCare Plus non-pregnant, non-disabled parents and caretakers with countable household income above 133% of the FPL will
no longer be eligible for
three months of backdated eligibility
. That is an applicant in the month of August will not be eligible for backdated eligibility for the month of July, 2012, if his/her income in July exceeded 133% of the FPL.
Children:
• Infants less than 1 year old with household income at or below 300% of the FPL
may qualify for retroactive eligibility;
• Children ages 1 though 5 (up to age 6) with household income at or below 185%
of the FPL may qualify for retroactive eligibility.
NOTE: Children ages 6 through 18 will remain eligible for three months of backdated
eligibility, if their income is at or below 150% of the FPL.
The Milwaukee Journal Sentinel reports the changes will lead to some 17,000 people
leaving programs or being turned away.
"State Sending Letters on Medicaid Changes." - JSOnline. Web. 02 May 2012.
<http://www.jsonline.com/news/statepolitics/state-sends-letters-on-health-coverage-rate-hikes-9v58pgg-149874685.html>.
WHAT THIS MEANS FOR YOU: TIME IS MONEY
Many approved applicants will no longer be eligible for three months of backdated eligibility. For accounts with more than 133% of the FPL, eligibility will only go back to the first day of the month the application was submitted.
Practical steps your facility can take:
1. Screening Patients at Admissions
Screening patients at admission will assist in getting those patients who qualify for
Medicaid into the application process in a timely manner. Since the new policy only
allows backdating to the first day of the month of application, not applying in a timely
manner could be detrimental to receiving payment for services provided.
2. Applying for Medicaid Day 1
Once your self-pay patient is categorized as eligible for Medicaid, the next step is
getting the application into the WI DHS day one. Any delay in applying this applicant
can result in non payment for the services provided.
Example: A patient comes to the hospital on June 25 for an emergency visit. The
application is not filed until July 5. Medicaid will only backdate to July 1, which
means your services you provided on from June 25 through June 30 will not be
covered.
3. Follow-Up (the most important step)
Intensive follow up, keeping all appointments and submitting all requested
documentation is critical to ensure you get paid. Failure to respond to certain requests
can result in denial of the application. The application can take up to 30 days to
process and if denied will result in losing the ability to backdate to cover your date of
service. Appealing these uncooperative denials can be difficult unless the patient is
able to prove extenuating circumstances in a timely manner.
Education and thorough follow-up is the key to ensure every step is completed to avoid
denial. Because the rules require swift action for Medicaid applications at the end of the
month, having staff understand the importance of a filed application is paramount.
Overall this new policy makes applying for Medicaid and covering services more
difficult and time consuming. HRS Erase is ready for this change and up to date on the
new policy with procedures set in place to be ready for July 1, 2012. HRS offers many
benefits to your facility in regards to eligibility to self-pay patients and applying for
Medicaid.
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