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We propose to implement BadgerCare Plus by emphasizing the importance of providing health insurance coverage to low-income families in order to facilitate and expand access to health care coverage for children under Title XXI. Our BadgerCare Plus proposal creates a seamless program of family health insurance by using both Titles XIX and XXI in order to provide insurance for the whole family.

Title XXI, Section 2105 provides CMS with the authority to waive requirements prohibiting the purchase of family coverage under Title XXI. This is possible provided the following two conditions are met: (1) such coverage is cost-effective relative to the amounts that the State would have paid to obtain comparable coverage only of the targeted low-income children involved; and (2) the coverage would not otherwise substitute for health insurance coverage that would be provided to such children but for the purchase of family coverage. In order to demonstrate compliance with Section 2105, we are providing the actuarial analysis found in section 6.3.2.1, which follows. The crowd-out provisions for BadgerCare Plus assure that only children who are not now covered would be eligible for health care.

6.4.2.1 Purchase of family coverage is cost-effective relative to the amounts that the state would have paid to obtain comparable coverage only of the targeted low-income children involved; and (Describe the associated costs for purchasing the family coverage relative to the coverage for the low income children.) (Section 2105(c)(3)(A)) (42 CFR 457.1010(a))

We have identified a benchmark health insurance plan that is available to all state employees. For purposes of assuring the reasonableness of access to the plan, for the basis of comparison, we chose the State Employee Standard Plan. The Standard Plan is the only health insurance option that is available to all state employees in all seventy-two Wisconsin counties.

Demographic assumptions. We assumed the following about the average BadgerCare family size, based on Wisconsin-specific 2000 U.S. Census data:

Children 1.91 Adults 1.14 Total 3.05

WISCONSIN

Effective Date:

Approval Date: 32