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An Analysis of Wisconsin’s ACCESS Online
    Application for BadgerCare Plus
                   Lindsey Leininger
        Chapin Hall at the University of Chicago

  Donna Friedsam, Kristen Voskuil, and Thomas DeLeire
            University of Wisconsin-Madison

                  November 5, 2011
                Presentation at APPAM




                                                        1
What is ACCESS?: https://access.wisconsin.gov/




                                                 2
What is ACCESS?: Part 2
• Am I Eligible?
  Anyone can submit minimal information on their
  household and receive feedback on whether they might
  be eligible for health care, nutrition or child care
  supplements, prescription drug assistance, energy
  assistance or tax credits.
• Apply for Benefits
  Submit application for BadgerCare
  Plus, Medicaid, FoodShare, child care and/or the Family
  Planning Waiver online. However, other steps must be
  taken for the process to be completed.


                                                            3
Am I Eligible and Apply for Benefits




                                       4
Methods of Application

• ACCESS

• Mail-in

• Walk-in

• Phone




                                     5
Research Questions
• What % of applications are received through ACCESS?
   – Are there differences in the socio-economic status of those that use
     ACCESS versus other methods of application?
• Target Efficiency of ACCESS: Is ACCESS more or less likely
  than other methods to attract applicants who are
  ultimately determined to be eligible for public insurance?
• Application and Eligibility Spillover: Does ACCESS promote
  greater likelihood of applying to other social programs?
  What are the rates of eligibility determination among
  “spillover” applications generated by ACCESS relative to
  other methods?



                                                                            6
Data : The Sample

• State contractor Deloitte selected a sample of those who
  applied for Health Insurance from January 2008 to October
  2010 through all methods.
• We restricted the sample to BC+ Child and Caretaker
  applications through November 2009 so we could match to
  the CARES demographic data we had at the time. CARES is
  the state’s eligibility database for BadgerCare Plus.
• We selected the oldest person listed in the case for
  individual demographic categories, typically a parent.



                                                              7
Results




          8
Percent of Applications by Method
             4%



       17%
                        ACCESS
                        Walk-in
      18%         62%   Mail-in
                        Phone




                                    9
Percent Determined Eligible for BC+ by Method
                                 100%
                                        87%
                                                 83%
                                 90%
 % determined eligible for BC+



                                                                   77%
                                 80%
                                                                            69%
                                 70%
                                 60%
                                 50%
                                 40%
                                 30%
                                 20%
                                 10%
                                  0%
                                        Phone   Walk-in           Mail-in   ACCESS

                                                   Application method
SES by Method
                    Application Method by Income

100%                                   85%
  80%                                                              ACCESS
           56%
  60%                                                              Walk-in
  40%                                                              Mail-in
                 22% 18%
  20%                         4%             5%   8%               Phone
                                                         2%
   0%
                 < 150% FPL                >= 150% FPL


Note: similar patterns emerge when the sample is stratified by other
potential markers of vulnerability (primary language, citizenship
status, rural status, gender)
Application Spillover by Method
80%
                            72% 72%
70%
              60%     63%
60%                                                         53%
          51%                                             46%
50%
                                                       41%
       38%
40%
                                                                      Jan08-Jun08
30%
                                                                      Jul08-Dec08
                                                 16%
20%                                                                   Jan09-Nov09
                                            6%
10%                                    4%

0%
         ACCESS         Walk-in         Mail-in         Phone
 Application spillover = % of BC+ applicants also applying for FoodShare
Eligible Spillover by Method
90%                                                         82%
                               74%             72%       75% 78%
80%
                        72% 72%
                                         63%
70%
                                                 60%
60%
           50%52%
50%     42%
40%                                                                      Jan08-Jun08
30%                                                                      Jul08-Dec08
20%                                                                      Jan09-Nov09
10%
 0%
            ACCESS          Walk-in         Mail-in         Phone
Eligible spillover = % of BC+ applicants applying for FoodShare (FS) who are
determined eligible for FS
ACCESS Going Forward

•   Wisconsin awarded federal Early Innovator grant to be
    used to expand ACCESS platform for planned private
    health insurance exchanges
•   Eliminating county-based walk-in services has been
    considered, instead relying almost exclusively on ACCESS
    – Generating considerable concern among advocate groups
•   Currently, ACCESS requires all submitted applications to
    be reviewed by a caseworker to verify and review
    information submitted. Cost/benefit analysis?
Acknowledgements
Funded by the Wisconsin Department of Health Services and
the Robert Wood Johnson Foundation
             For Further Information
Leininger, Friedsam, Voskuil, and DeLeire “The Target
Efficiency of Online Medicaid/CHIP Enrollment: An Evaluation
of Wisconsin’s ACCESS Internet Portal” available at:
www.rwjf.org
Leininger, Friedsam, Voskuil, and DeLeire “Online Application
for Medicaid and BadgerCare: How Efficient Relative to Other
Application Venues?” available at
www.uwphi.pophealth.wisc.edu


                                                                15

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APPAM 2011 DeLeire Slides

  • 1. An Analysis of Wisconsin’s ACCESS Online Application for BadgerCare Plus Lindsey Leininger Chapin Hall at the University of Chicago Donna Friedsam, Kristen Voskuil, and Thomas DeLeire University of Wisconsin-Madison November 5, 2011 Presentation at APPAM 1
  • 2. What is ACCESS?: https://access.wisconsin.gov/ 2
  • 3. What is ACCESS?: Part 2 • Am I Eligible? Anyone can submit minimal information on their household and receive feedback on whether they might be eligible for health care, nutrition or child care supplements, prescription drug assistance, energy assistance or tax credits. • Apply for Benefits Submit application for BadgerCare Plus, Medicaid, FoodShare, child care and/or the Family Planning Waiver online. However, other steps must be taken for the process to be completed. 3
  • 4. Am I Eligible and Apply for Benefits 4
  • 5. Methods of Application • ACCESS • Mail-in • Walk-in • Phone 5
  • 6. Research Questions • What % of applications are received through ACCESS? – Are there differences in the socio-economic status of those that use ACCESS versus other methods of application? • Target Efficiency of ACCESS: Is ACCESS more or less likely than other methods to attract applicants who are ultimately determined to be eligible for public insurance? • Application and Eligibility Spillover: Does ACCESS promote greater likelihood of applying to other social programs? What are the rates of eligibility determination among “spillover” applications generated by ACCESS relative to other methods? 6
  • 7. Data : The Sample • State contractor Deloitte selected a sample of those who applied for Health Insurance from January 2008 to October 2010 through all methods. • We restricted the sample to BC+ Child and Caretaker applications through November 2009 so we could match to the CARES demographic data we had at the time. CARES is the state’s eligibility database for BadgerCare Plus. • We selected the oldest person listed in the case for individual demographic categories, typically a parent. 7
  • 9. Percent of Applications by Method 4% 17% ACCESS Walk-in 18% 62% Mail-in Phone 9
  • 10. Percent Determined Eligible for BC+ by Method 100% 87% 83% 90% % determined eligible for BC+ 77% 80% 69% 70% 60% 50% 40% 30% 20% 10% 0% Phone Walk-in Mail-in ACCESS Application method
  • 11. SES by Method Application Method by Income 100% 85% 80% ACCESS 56% 60% Walk-in 40% Mail-in 22% 18% 20% 4% 5% 8% Phone 2% 0% < 150% FPL >= 150% FPL Note: similar patterns emerge when the sample is stratified by other potential markers of vulnerability (primary language, citizenship status, rural status, gender)
  • 12. Application Spillover by Method 80% 72% 72% 70% 60% 63% 60% 53% 51% 46% 50% 41% 38% 40% Jan08-Jun08 30% Jul08-Dec08 16% 20% Jan09-Nov09 6% 10% 4% 0% ACCESS Walk-in Mail-in Phone Application spillover = % of BC+ applicants also applying for FoodShare
  • 13. Eligible Spillover by Method 90% 82% 74% 72% 75% 78% 80% 72% 72% 63% 70% 60% 60% 50%52% 50% 42% 40% Jan08-Jun08 30% Jul08-Dec08 20% Jan09-Nov09 10% 0% ACCESS Walk-in Mail-in Phone Eligible spillover = % of BC+ applicants applying for FoodShare (FS) who are determined eligible for FS
  • 14. ACCESS Going Forward • Wisconsin awarded federal Early Innovator grant to be used to expand ACCESS platform for planned private health insurance exchanges • Eliminating county-based walk-in services has been considered, instead relying almost exclusively on ACCESS – Generating considerable concern among advocate groups • Currently, ACCESS requires all submitted applications to be reviewed by a caseworker to verify and review information submitted. Cost/benefit analysis?
  • 15. Acknowledgements Funded by the Wisconsin Department of Health Services and the Robert Wood Johnson Foundation For Further Information Leininger, Friedsam, Voskuil, and DeLeire “The Target Efficiency of Online Medicaid/CHIP Enrollment: An Evaluation of Wisconsin’s ACCESS Internet Portal” available at: www.rwjf.org Leininger, Friedsam, Voskuil, and DeLeire “Online Application for Medicaid and BadgerCare: How Efficient Relative to Other Application Venues?” available at www.uwphi.pophealth.wisc.edu 15