Health insurance networks in more than two-thirds of Wisconsin counties don’t meet certain federal standards for pediatric care access, according to the state Office of the Commissioner of Insurance.
OCI yesterday released its Wisconsin Individual Health Insurance Market Analysis report, conducted by consulting firm BerryDunn for the agency as part of an effort to reduce the number of uninsured state residents. It’s the last of a series of studies commissioned on this topic, the agency said in the release.
Among other findings, the analysis found insurance networks in 52 Wisconsin counties don’t meet pediatric primary care access standards set by the Centers for Medicare and Medicaid Services. The agency notes that standard is impacted by rural patient behaviors, as they typically access care through a family practitioner rather than a pediatrician.
It also found health insurers’ networks in 34 counties don’t meet CMS standards for OB/GYN access, which requires the presence of both pediatricians and obstetricians-gynecologists, the report shows. Rural family practitioners are more likely than those in urban areas to provide obstetrical deliveries, newborn care, and pediatric care.
“The findings in this report will assist us in our work to ensure that every person who enrolls in health insurance coverage can access the care covered by their plan,” Insurance Commissioner Nathan Houdek said in a statement.
Forty-seven percent of the state’s 312,000 uninsured residents are estimated to be eligible for Marketplace-based premium tax credits, while 28% are estimated to be eligible for Medicaid or BadgerCare, according to the report. The ongoing open enrollment period for 2024 coverage runs through Jan. 15.
The statewide uninsured rate was 5.5% in 2020, though people with lower incomes as well as people of color and Hispanic or Latino residents are “substantially” less likely to be insured.
While Clark and Menominee Counties have the highest percentage of uninsured residents — at more than 20% each — more populated areas of the state house a larger number of these people.
“The numbers of uninsured in Milwaukee, overall, and for its racial and ethnic subpopulations, far exceed the total population of uninsured residents in any other Wisconsin county,” report authors wrote. “Milwaukee has 54,665 uninsured residents, and Madison has 9,898 uninsured residents — both substantially higher than Clark and Menominee Counties.”
The report shows adults aged 18-34 years represent a shrinking segment of individual market enrollees in Wisconsin, making up a large portion of the uninsured population. Report authors say targeted efforts to boost enrollment in this age range “will improve the individual risk pool and help reduce premium rates overall — attracting enrollment by others and further reducing the uninsured rate.”
It also includes a section on the Medicaid unwinding process, taking place following the end of the continuous coverage requirement enacted during the COVID-19 public health emergency. Medicaid/BadgerCare enrollment rose 28% from January 2020 to March 2022, gaining 296,000 members, as disenrollment and eligibility redeterminations were temporarily halted during the pandemic.
Report authors reference a 2021 Urban Institute study that projected states would return to pre-pandemic coverage levels by the fourth quarter of this year. It found about one-third of adults losing Medicaid may be eligible for subsidized Affordable Care Act marketplace plans.
Still, projections of future marketplace enrollment in the state “do not indicate expectation of substantial net growth” despite the ongoing unwinding process.
See the full report: https://oci.wi.gov/Documents/Consumers/Market_Analysis_Final_Report_Aug2022.pdf
See the release: https://www.wispolitics.com/2023/office-of-the-commissioner-of-insurance-releases-new-study-analyzing-network-adequacy/
–By Alex Moe
