A new health care manager in the Milwaukee area will test theories on health care and insurance advocated in this column for years.
Trilogy Health Service – formed by insurance industry veterans and about 900 physicians – contracted with state Department of Health Services to manage BadgerCare Plus and Medicaid in four Milwaukee area counties.
Enrollment began March 1. The goal is 11,000 enrollees by year’s end.
Basis for this column’s health plan:
“The country is too big and too varied for a single plan out of Washington to work. Medical costs and availability are different in metropolitan areas than in rural areas. Using state programs, similar to BadgerCare, would in likelihood reduce the federal cost share and be more responsive to those needing insurance.”
Center for Medicare/Medicaid Services (CMS) manages both programs, determining health care, amount of a bill to pay and time lines.
Medicare covers most people over 65 and is partially financed by a monthly deduction from Social Security – currently about $105 for everyone.
BadgerCare Plus oversees Medicaid and other county and state managed health programs.
Medicaid, approved in the Social Security amendment of 1965, is a federal program that contributes $2 for each state $1, with the amount determined by the local investment.
Why not handle Medicare/Medicaid through the state insurance plan, using it the same as “Medicare Advantage” under private plans?”
Trilogy’s performance will proof the End Stool theorem as it manages BadgerCare Plus and Medicaid in Milwaukee, Ozaukee, Racine and Waukesha counties.
Independent Physicians Network, with about 900 physicians, and insurance industry veterans give Trilogy a good prognosis.
“Wealth of Medicaid health experience,” is cited by Bonita Warner, Trilogy president and Medicaid executive, recruited from United HealthCare, a similar business.
Health care groups contract with the state to receive a set amount to pay bills of low-income adults and dependent children covered by BadgerCare. Medicare Advantage providers make similar contracts with CMS.
Trilogy also will manage care of people on limited incomes covered by Medicaid or a combination of Medicaid and Medicare.
In December, more than 250,000 adults and children were covered by BadgerCare Plus in the four county area.
Starting April 1, it will cover adults with no children under 19 below the poverty line – $11,400 for an individual. Adults with incomes above the threshold will be eligible for subsidized health plans sold on the federal market place set up through the Affordable Health Care Act.
More than 100,000 additional people – those over 65 and eligible for Supplemental Security Income – are covered by other Medicaid programs in the four counties.
Expanded eligibility could significantly increase the size of the potential market. One out of five Wisconsin residents is served in various programs – traditional Medicaid, BadgerCare Plus, Senior Care or Family Care.
My issue with CMS is not about health care. It is determining the amount of a bill it approves – most often 30 percent or less, or none at all.
At 30 percent, CMS pays $24 of a $100 bill. An ad promoting supplemental insurance, only states Medicare will pay 80 percent of a bill, leaving the impression it pays $80. The patient, or their insurance, pays $6 of the $30 allowed by CMS.
It does not take an accountant to see that this endangers the future of a health care system that meets the people’s needs.