BC+ CORE PLAN & Enrollment Services Center Theresa Fosbinder DHS/BEM/ESC (Dates subject to change)

1. BC+ CORE PLAN& Enrollment Services CenterTheresa FosbinderDHS/BEM/ESC(Dates subject to change)

2. THE BADGERCARE PLUS CORE PLAN (FOR ADULTS WITHOUT DEPENDENT CHILDREN&THE ENROLLMENT SERVICES CENTER (ESC)

3. Who are the Adults Without Dependent Children? These are individuals and married couples who are: • Between the ages of 19 and 64 • Not pregnant, disabled, or qualified for any other Medicaid, Medicare or SCHIP program • May have children, but either their minor children are not currently living with them (40 percent of the time) or those children living with them are 19 years of age or older.

4. What are the Eligibility and Enrollment requirements and rules for the BC+ Core Plan? • Payment of an annual application processing fee of $60 or $75 (depending on HMO selected) • Income up to 200% of the Federal Poverty Level (FPL) • Federal Requirements: • Not covered by private health insurance for the previous 12 months • No access to employer-sponsored health insurance for the previous 12 months • Applicants will need to complete a Health Survey

5. What are the Eligibility and Enrollment requirements and rules for the BC+ Core Plan? • Physical Exam (first year requirement) • Failure to obtain = loss of eligibility for 6 months (with good cause exemptions) • HMOs are required to provide access for exams to avoid penalty • This requirement is unique among state Medicaid programs. • Reporting requirements: • Move out of state, turn 65, change living arrangement, death, or become eligible for BC+, Medicaid or Medicare.

6. What are the Eligibility and Enrollment requirements and rules for the BC+ Core Plan? • CARES will create a BCLA AG for each eligible individual and his/her benefits are frozen for a year. • The first date that core plan services will available is July 1, 2009. Those enrolled on or after that date will receive a Forward Health card and will be able to use it wherever providers will accept it (i.e. “fee-for-service”) until HMO enrollment occurs at a later date.

7. How will the BC+ Core Plan and other programs for this population be administered? • Applications and other interactions for the childless adult population will be processed centrally by the Enrollment Services Center (ESC). • Individuals can apply in the following ways: • Online at access.wisconsin.gov • Via phone at the ESC • The ESC will be comprised of a combination of state and vendor staff – the vendor involved is Automated Health Systems (AHS).

8. The ESC • The ESC will include the following functions, managed in conjunction with the vendor: • Mailroom and scanning services • Application and renewal services • Eligibility processing services • HMO Enrollment services • Member services • Fiscal services • Other services, including benefit recovery, fair hearing and grievances, outreach and field representatives

9. The ESC • The ESC will be responsible for managing the following programs for this population: • BadgerCare Plus Core Plan for Adults Without Dependent Children • FoodShare • Other Health Care programs for spouses of a childless adult (excluding Long Term Care/institutions and Medicaid Purchase Plan (MAPP) • All Family Planning Waiver only cases – regardless of age of the member – unless other members of the household are eligible for BadgerCare Plus or Medicaid.

10. The ESC • Under the ESC umbrella, AHS will continue to offer HMO “enrollment broker” services for BC+ Families and SSI recipients. This process will not change. Note: Well Woman Medicaid will become centrally administered at a later date via a separate process.

11. ESC Service Delivery Model (as of 4/21/09)

12. IMPLEMENTATION PLAN

13. Communication Plan Program Policy and Process • Administrator’s Memo 09-01 • BC+ Handbook Chapter 43 (Core Plan) • Core Plan Fact Sheets http://badgercareplus.org/core/publications.htm • Operations Memo • Process Help • CARES Updates • RAQs

14. CARES: How is the ESC set up? The ESC will be identified by a new ‘county’ and office as listed below. The ESC will consist of private and public workers. • New County / Tribe code (Reference Table TCTY): 74 – ESC • New Office: 5074 • New Profiles: • Private worker profile • Security Level 25 or 50 • Public worker profile • Security Level 50 • Private workers will not be able to confirm cases on AGEC (RACF change) • New field “County of Residence” at the case level will track where the applicant lives for reporting purposes

15. CARES: How is the ESC set up? • All letters and notices of cases belonging to the ESC will use the ESC contact information. • Cases and applications will be assigned to specific workers in the ESC (same as County); however, any worker in the ESC may be responsible for performing functions on any application / case. • ESC and Counties will be able to use existing application / case transfer functionality to transfer applications / cases back and forth

16. Local agencies: What is their role? • Local agencies will continue to serve: • Families • Pregnant Women • Elderly and/or Disabled

17. The following programs will still be administered in the local agencies • BadgerCare Plus • Medicaid, including Long Term Care/institutions and MAPP • Medicare Premium Assistance • FoodShare • Caretaker Supplement • Child Care • W-2 • FSET • Children First

18. Agencies will also serve as • Mailing address for ESC managed homeless participants • Pick up point for Food Share vault cards for ESC managed members • FSET management for ESC managed members • Drug felon testing

19. How will applications be routed? • IN ACCESS: ACCESS will be programmed to recognize situations which should go to the local agency vs. those that should go to the ESC. • At application: Applicants will be directed to the ESC and/or screened and an RFA done and transferred there as appropriate. • At renewal: The system will prompt the agency workers to transfer a case after completion of the next scheduled review if the case meets the ESC criteria.

20. ACCESS AFB applications will be routed to ESC if: • PP or PP's spouse is a CLA with a Health Care request (AND / OR) • PP is a CLA with a FPW / FS request or a FPW only request

21. ESC will keep cases if: • PP or PP's spouse is a CLA open for BC+ Core Plan or FPW (AND / OR) • PP is a CLA open for FS

22. Transferring cases at review • Once instructions have been given to do so, existing county cases can be transferred to ESC after completing review if: • PP is a CLA open for FPW / FS (AND) • PP's spouse is not open for other Health Care programs (BC+, EBD, Waivers, LTC) (AND) • CC and W-2 are not open in the case • A message will display on AGEC instructing the worker when it is appropriate to transfer the case.

23. ESC cases • An ESC indicator at the case level will be displayed on the Case Summary page. This indicates if the PP or PP’s spouse meets the ESC criteria. The system will update this indicator as and when the corresponding information is updated in CWW. (Pregnancy, Age, Relationships, Disability, etc)

24. What happens if there are case changes to an ESC case that result in other health care? • Core plan customers will inform the ESC of changes that result in eligibility for other BC+ or Medicaid plans. This would include reported: • Pregnancy • Disability/MAPP disability • Kids in home • Change in living arrangement.

25. What happens if there are case changes to an ESC case that result in other health care? • In these situations the ESC will enter the reported data. This will result in closure of the core plan, and the new health care plan opening or pending. If the change results in closure of the core plan and a new health care plan opening, the ESC will transfer the case to the local agency. • Note: In situations of reported pregnancy, the Core Plan will not be closed and the case will not be transferred to the local agency until the BC+ standard or benchmark plan opens.

26. Will there be companion and/or shared cases? • Companion Cases • Core plan individual with spouse requesting LTC (Family Care or Community Waivers) • Unrelated individuals with a non-qualifying relationship for BC+ or Medicaid in a FS case that includes the core plan

27. Will there be companion and/or shared cases? • Shared Cases • Core plan individual living with a child less than 40% of the time requesting for CC • Core plan individual with pregnant spouse requesting W2 • Core plan individual requesting W2 as a non-custodial parent

28. Will there be companion and/or shared cases? • Anytime a case is shared between a county and ESC, it will ‘belong’ to the county and assigned to a worker in the county. But the ESC workers will still have access to update any page on the case. • Any changes made by a county worker on a shared case will alert the county coordinator of the ESC. Any changes made by an ESC worker on a shared case will alert the permanent worker assigned to the case in the county. County workers can confirm any AG except BCLA on a shared case.

29. How will cases be transferred? • Counties can ‘pull’ or ‘push’ cases from/to the ESC on the Agency Transfer page. When a case is transferred to a county with the ESC indicator as ‘Yes’, the ESC workers will still have update access to the case.