Wisconsin program grapples with training, access
Wisconsin’s welfare reform program, known as Wisconsin Works or W-2, continues to be hailed by many analysts as a national model. However, like many states, Wisconsin has been struggling with how to ensure that many residents who have moved off welfare still receive Medicaid benefits.
Some health centers have reported a significant decrease in their medical assistance recipients, in part because clients no longer realize they are eligible for services or because they have been confused or discouraged by the recertification process. Wisconsin has responded by launching an aggressive outreach program to communicate with former welfare recipients.
Central to the state’s efforts is a plan to "outstation" county eligibility workers in the community, including federally qualified health centers. Susan Wood, chief of the Medicaid Eligibility Section for the Wisconsin Department of Health and Family Services, said there have been some delays waiting for legislative approval, but the agency has spending authority and is finalizing contracts with county agencies.
"Most outreach workers are in place in Milwaukee and Kenosha counties, which have the highest concentration of Medicaid eligibles," she said, "although we are still working to resolve technology problems at some of the sites so workers can access the databases."
Other keys to the outreach effort include the following:
• pilot-testing expanded evening and weekend hours and redesigning notices to applicants and recipients about their eligibility status;
• analysis of caseload trends and Wisconsin Family Health Survey data to identify characteristics of low-income uninsured families and to provide county-specific data;
• enrolling more than 1,000 county and W-2 staff in a course on the basics of eligibility and how to apply for Medicaid;
• targeting a mailing to 17,000 Medicaid families who had cases closed in 1997 with information on how employment affects Medicaid eligibility and the differences between Medicaid and W-2.
Celeste Schulz, a health care advocate with Community Advocates, Milwaukee, said that while the state is trying to reach out, she is "still seeing a lot of cases of people who are not getting access to caseworkers."
"Lots of things are supposed to happen," she said, "but they haven’t happened yet. Caseworkers have been switched for many clients because of new regions for the Wisconsin Works welfare reform program, but the clients don’t know that and they can’t find their worker. It’s confusing because people don’t know they can apply for Medicaid without being on welfare."
Linda Hall, a health care policy analyst for the Wisconsin Council on Children and Families, said that while the "precipitous drop in the number of children on Medicaid" is starting to level out, the caseload is still far below what it had been.
Some of the state’s outreach efforts were dealt a setback in August when the Health Care Financing Administration (HCFA) rejected much of the state’s BadgerCare program to provide 50,000 low-income, non-Medicaid-eligible families with health insurance by combining federal Child Health Insurance Program money, state funds and premiums paid by BadgerCare participants. The state was planning to link its advertising efforts for BadgerCare and Medicaid outreach. HCFA gave the state approval to cover only children between the ages of 14 and 18 under BadgerCare.
Ms. Hall said she hopes state officials will move aggressively to resolve technology problems over the next few months so workers will have computer access to all the database information they need. She also is seeking to ensure that Department of Health and Family Services staff work with administrators of the W-2 program and local offices to inform people that children are eligible for health-care services.
Ms. Hall said she also hopes to ensure that people who do sign up are actually enrolled. "During outreach for the Healthy Start program, there were assertions that the numbers seen never equaled the projected caseload, and rumors that county officials in Milwaukee County actually told staff not to work too hard at enrolling people," she said.
Sharon Cabraal, a staff attorney with Legal Action of Wisconsin, sees problems implementing outreach to Medicaid eligibles because of a "tug-of-war" between the Department of Health and Family Services and the Department of Workforce Development over authority and funding to do the work.
She noted that the state’s Medicaid enrollment was at an all-time high in 1994 and in 1997 hit an all-time low. It has remained at the low number, with some increase in Healthy Start enrollment and some increase in a Medicaid extension program that gives workers without benefits an extra year of Medicaid coverage.
As an example of problems that have arisen, Ms. Cabraal said 65% of the letters from the state advising people who were dropped from the Medicaid rolls when W-2 was implemented to reapply for Medicaid were returned as undeliverable. "These people move a lot," she said, "and they should be sending letters using addresses from the school lunch program because they would be more current."
Ms. Cabraal praised training that has been given to caseworkers to help them better understand the new eligibility rules and said it needs to be ongoing, noting a case when a supervisor didn’t understand the rules and denied an application for Medicaid extension to which a client was entitled.
She expressed hope the state will soon follow through on a promise to establish a special unit of workers trained to resolve eligibility problems and available to help caseworkers and advocates on particular cases. She said the staff at the Medicaid recipient hotline, who had been a good source of information, now can only say if a case is open and can’t give eligibility or other information.
The attorney said that while the state has published some informational materials on the changes, it is necessary to actually identify people at the places where they are. Many people have the idea that they’re not eligible for Medicaid and that notion is not being corrected by the workers, she said.
Outstations ready by December
Ms. Wood of the Department of Health and Family Services said the department expects to complete the process of outstationing eligibility workers in the state by the end of the year. She noted that a letter has been sent to all counties, telling them what services are available and urging them to take advantage of the offer to post and financially support outreach workers in their locale.
Other priorities for the rest of the year include continuing to train eligibility workers on the "very complicated" regulations that apply and offering training to community agencies so they can help their clients; ensuring that caseworkers have computer query access to the database so they can resolve problems; and issuing a request for proposals to community-based agencies for outreach efforts that can be funded through a $500,000 appropriation.
Ms. Hall of Wisconsin Council on Children and Families said state officials "have designed a reasonable program. We just have to be sure that it works." She said the council worked hard to have evaluation funded as part of the new outreach program. The legislature agreed, and there will be a determination of which outreach elements do and do not work.
Contact Ms. Wood at (608) 266-5635; Ms. Schulz at (414) 449-4777; Ms. Hall at (608) 257-5939; and Ms. Cabraal at (414) 278-7722
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