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Presentation by Tom DeLeire at AcademyHealth 2010 ARM
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University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
Getting Parents Enrolled in Medicaid: Lessons from
Wisconsin‘s BadgerCare Plus Auto-Enrollment Process
Thomas DeLeireLindsey Leininger, Laura Dague, Shannon Mok,
Donna FriedsamUniversity of Wisconsin-Madison
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
Health Care Reform• A key coverage component of the law is an
expansion of Medicaid to 133% FPL– CBO estimates that roughly 50% of the increase
in coverage will come from Medicaid expansion
• Low-income parents represent an appreciable portion of the newly eligible population– 4.1 million or 34% of newly eligible adults
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
Enrollment of Eligible Persons• Many eligible individuals do not enroll in
Medicaid– 75% of uninsured children and 28% of
uninsured parents are eligible for public insurance (Holahan et al., 2007)
• Getting uninsured individuals enrolled quickly may be important for improving health (McWilliams et al., 2009)
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
Auto-Enrollment Should be Considered for Health Reform Implementation
• Outline– Wisconsin’s experience with auto-enrollment– National and state by state estimates of the
number of parents that could be auto-enrolled
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
The Launch of • WI’s BadgerCare+ : joint Medicaid & CHIP
program
• Massive reform effort launched in Feb. 2008• Eligibility expansion• Auto-enrollment• Simplification of enrollment and recertification
processes• Aggressive marketing campaign
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
Auto-Enrollment in Wisconsin• WI implemented a one-time “auto-
conversion” effort immediately prior to BC+ program launch – Auto-enrolled 44,000 previously ineligible or
pending applicants • Applied new program eligibility criteria to
previously ineligible individuals for whom there was current administrative data
• 92% of were siblings and/or parents of existing beneficiaries
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
Auto-Enrollment in Wisconsin• Anyone who had a family member enrolled
in state health programs in December 2007 or January 2008), or who had had a case closed 30 days prior were auto-enrolled
• 44,000 auto-enrollees out of almost 70,000 individuals newly enrolled in the first month
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
Kaplan-Meier Estimates of Disenrollment by Auto-Enrollment
0.0
00
.25
0.5
00
.75
1.0
0L
ike
liho
od
of
dis
en
rollm
en
t
0 5 10 15 20M o nths s in ce enro lled
O the r F eb rua ry e nro llee s A utoe nro llee s
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
Auto-Converts vs. Other New February 2008 Entrants
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
Auto-Enrollment Potentially Useful In Federal Reform
•American Community Survey, 2008
•Calculate the number of parents who would become newly eligible under 133% FPL eligibility
•Calculate what fraction of these have children already on public insurance
•Calculate what fraction of these are currently uninsured
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
LEGEND
Not Applicable
23% (min) to 45%
45% to 60%
60% to 78% (max)
Percent of Newly Eligible Parents Who Are Potential Auto-Enrollees
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
Percent of Potential Auto-Enrollees with Private Health Insurance
LEGEND
Not Applicable
14% (min) to 25%
25% to 35%
35% to 41%(max)
University of Wisconsin
POPULATION HEALTH INSTITUTE
Translating Research into Policy and Practice
Conclusion• Auto-enrollment of parents
– Should be feasible given many existing data systems
– Has the potential to enroll 2.3 million parents immediately upon program expansion
– Is target efficient as 75% of these parents are uninsured