Healthcare Prescription: Medicaid and the Marketplace - WXOW News 19 La Crosse, WI – News, Weather and Sports |

Healthcare Prescription: Medicaid and the Marketplace

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LA CROSSE, Wisconsin (WXOW)-- Part of the Affordable Care Act, commonly known as Obamacare, states had the option of implementing an expansion of medicaid, partially funded by the federal government.

Wisconsin is among the states that rejected the expansion and Gov. Scott Walker decided to instead to make changes to the state's medicaid program. Eligibility for Wisconsin's Medicaid program, known as BadgerCare, will change beginning Jan. 1 of 2014 and an estimated 92,000 Wisconsinites will lose BadgerCare coverage and need to buy private insurance.

"The people who will be losing Medicaid coverage will be people who are caregivers of children, so the children won't lose, but the caregivers may depending on their income level," said Michael Richards of Gundersen Health System.

The new BadgerCare rules require recipients to make less than 100 percent of the federal poverty level, for an individual that's about $960 a month or less and for a family of four it's about $2000 a month or less. And income will be determined by an person's most recent tax return, rather than the last few months of income that is currently used.

"That's a big change too, for the BadgerCare program, we want our program in WI to align with what the marketplace is using for the qualified health plans so the BadgerCare eligibility rules are changing and we're going to use their last year's taxes, their adjusted gross income," said Lorie Graff, Western Consortium Income Maintenance Manager.

The new rules also mean there's no limit to the number of people who can be on BadgerCare and anyone on the existing waiting list below 100 percent of federal poverty level threshold will automatically qualify.

"A lot of the childless adults that we talked about have been on the waiting list and haven't been able to get Medicaid coverage," Richard said. "That is going away and what's going to happen now is you're going to see more of those people being able to automatically enroll in Medicaid."

Those losing BadgerCare coverage need to buy private insurance in the marketplace to comply with the individual mandate and avoid paying a penalty.

"The exchange or the marketplace is really based on not having to pay over 8 percent of your annual income. and so that's why the advanced premium tax credits are in there and out of pocket costs maximums," Graff said.

BadgerCare status will not change if you are pregnant, under 18, blind, disabled or elderly. Anyone on BadgerCare or on the waiting list will receive letters this week indicating if they still qualify and the steps they need to take.

To help with the process you can meet with a certified application counselor at your local health department. It's free and the trained person will walk you through signing up for BadgerCare or purchasing insurance in the marketplace.

In addition to deciding whether or not to expand medicaid, states also got to chose the type of insurance marketplace that would operate in their state. States could set up their own or let the federal government set it up.

Minnesota set up there own, while Wisconsin chose the federal government set up. While the marketplaces will look a little different state by state, the core requirements will be the same.

"The insurance products are going to have to have the essential benefits that are going to have to be covered," Richard said. "They're going to have the metal tiers- the platinum, gold, silver and bronze, but they'll look a little bit different. And they may have a little different requirement son there, but for the most part, they're going to have the same basic content."

The marketplaces will open October 1. Until then we won't know exactly what any of the market places will look like or the exact prices of plans that will be offered.

For more information on the Affordable Care Act you can go to www.healthcare.gov.

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