Our search for interesting state innovations brings us once again to Wisconsin. The last time we sent you a postcard from Wisconsin, we highlighted its successful ACCESS program that allows people to apply online, check the status of their benefits, and report any changes. In this case, the state has moved forward to take advantage of one of the new opportunities afforded by the CHIPRA law – the ability to cover lawfully residing immigrant children and pregnant women without a five-year waiting period.
Wisconsin is making progress in ensuring that “covering all kids” means “all kids.” To get the story behind this policy change, CCF’s Joan Alker spoke to Jon Peacock of the Wisconsin Council on Children and Families.
CCF
Since Wisconsin Governor Jim Doyle first proposed the BadgerCare Plus program in 2006, he has consistently said that the goal was to make quality, affordable health insurance available to “all kids,” regardless of income. How close is Wisconsin to achieving that goal?
Jon
Implementation of BadgerCare Plus (BC+) began in 2008, and the strong “all kids” message has been extremely effective. Since the program’s initiation, enrollment has increased by more than 116,000 children, or almost 38%. (Total coverage of kids, parents, and pregnant women has increased by more than 190,000, or 39%.)
Nevertheless, advocates would sometimes cringe when we heard the “all kids” message, because there was an unspoken caveat – immigrant children weren’t eligible unless they were citizens or had resided lawfully in the U.S. for at least 5 years. Although we understand the value of a strong uncluttered message, we also know that a five-year wait is a lifetime for a young child, and that made the unspoken asterisk very disturbing. The good news is that the caveat is shrinking.
CCF
By that, Jon, I think you mean Wisconsin’s decision to take advantage of the new “ICHIA” provision in the CHIPRA law?
Jon
That’s correct. The Wisconsin Department of Health Services (DHS) announced this fall (via Operations Memo # 09-57 99 download below) that it was taking advantage of a provision in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) that allows states to get federal matching funds for extending health insurance to certain “lawfully residing” immigrant children and pregnant women. As a result, those Wisconsin children and women will no longer have to reside in the U.S. for 5 years before they are eligible for BC+
CCF
I’m sure that’s quite a relief to immigrant families in Wisconsin who are having a tough time finding affordable health coverage. How many people will this policy change help.
Jon
The change in policy won’t affect a large number of people, but it removes one of the more significant impediments to serving low-income kids, and brings Wisconsin much closer to fulfilling the Governor’s commitment to make health care accessible for all kids. DHS began implementing the change in October 2009 and quickly used automatic enrollment for 578 lawfully present immigrants (children and pregnant women) in open cases in the state’s computer database. That number should gradually but steadily grow over the coming years, as we reach out to the immigrant families whose children are now eligible but weren’t already in the DHS database.
CCF
How will it help?
Removing the 5-year bar for immigrant children yields obvious benefits by making hundreds of additional children eligible. The change is also likely to help enroll some citizen children because the message that all lawfully residing kids are eligible will create a “welcome mat” effect for many mixed-status families. With respect to pregnant women, the benefits of removing the 5-year bar are also significant, although those improvements are much less obvious because Wisconsin had already been using the fetus option (known in our state as BadgerCare Plus Prenatal) to cover pregnant women whose immigrant status excluded them from participation in BC+.
CCF
How will this policy change help pregnant immigrant women?
Jon
The Wisconsin Council on Children and Families explored that matter in an analysis of the options for improving coverage of pregnant immigrants. We concluded that lifting the 5-year bar would have a number of significant advantages for the affected women and for the state’s health care system. Perhaps the most important of those is that low-income immigrant women who are newly eligible for BC+ will no longer be excluded from coverage when their employer offers insurance that they can’t afford. The new option will also ensure that pregnant women have access to the full range of BC+ coverage, and – by expanding the use of presumptive eligibility and providing continuous enrollment for the duration of a pregnancy – the changes will make it more likely that the immigrant women receive the timely prenatal care that is so important for healthy birth outcomes.
CCF
Have you run into any roadblocks in getting this policy change through?
Jon
As we examined the ramifications of removing the 5-year bar, we were surprised to learn that federal officials still haven’t decided exactly which children and pregnant women will be affected. Federal guidance on that issue might be issued sometime in the next few months. In the meantime, the WI DHS has removed the 5-year bar for the kids and pregnant women in categories the state can clearly allow to participate. As we explain in another short issue paper, the final federal interpretation is likely to go further than Wisconsin has allowed. For example, it might allow states to cover asylum applicants, immigrants in temporary protected status, or certain immigrant spouses and children of citizens. Once CMS issues guidance on how it is defining lawfully residing, Wisconsin should reexamine its options for implementing the new law.
CCF
So what’s next for Wisconsin?
Jon
One thing that is clear is that the CHIPRA law does not give states the ability to use CHIP or Medicaid funds to insure immigrant children who are undocumented, or even for the non-citizen children of legally present immigrants on temporary work permits. One option for covering immigrants not eligible under CHIPRA is to allow them to obtain insurance through the new exchanges that would be established under the national health care reform legislation. However, those exchanges won’t begin for several years, and many low-income immigrants won’t be able to afford that coverage. As an alternative, we would love to see Wisconsin follow the lead of states like Illinois and Washington that extended coverage to undocumented immigrant children with 100% state funding.
Wisconsin and other states are making progress toward the goal of ensuring that “all kids” means just that. To continue that progress, we must now work to allow all immigrants to participate in the new health exchanges (should health reform be enacted) and to fund Medicaid or CHIP coverage for all low-income immigrant children.
CCF
Thanks, Jon, and congratulations on all the progress being made in covering children and pregnant women in Wisconsin.
For more information on the CHIPRA option to cover lawfully-residing immigrant children and pregnant women, see CHIP Tips: New Federal Funding Available to Cover Immigrant Children and Women.
