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Monday, September 22, 2014 |  Madison, WI: 60.0° F  Fair
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Cut off from BadgerCare, again
State health-care plan is quick to give families the boot
Ochs, with Caleb: 'Their policies need to change.'
Maria Ochs, with Caleb: 'Their policies need to change.'

Maria Ochs doesn't want to be a burden on the government. The Madison resident works hard to support herself and her 10-year-old son. She doesn't accept food stamps or other forms of available assistance. But she does rely on the state for health-care coverage. Because of this, the government is sometimes a burden on her.

"I'm doing the best I can," says Ochs, a 29-year-old single mom. "I'm trying to be a beneficial member of society. They're not making it easier to do that."

Ochs and her son are among the 98,000 Wisconsin residents covered by BadgerCare. They have no choice. Her son, Caleb, has gastrointestinal and behavioral problems that require regular doctor visits and medication. These count as preexisting conditions, meaning she can't switch to the plan offered by her employer.

Twice in the last year, Ochs and her son have been kicked off of BadgerCare. Both times, she says, it was through no fault of her own.

The first time was last November, when the state lost some paperwork and her state case worker repeatedly ignored her calls. Andy Heidt, ombudsman for the Dane County Human Services Department, helped get Ochs back on the plan - and a new caseworker.

But for three months, Ochs "had to pay out-of-pocket for my son's medications" - about $300 a month. She still has about $300 in outstanding bills from doctor visits.

On Saturday, Oct. 20, Ochs opened her mail to find a stern letter notifying her that both she and Caleb were again kicked off the program, because "The BadgerCare premium has not been paid." The letter said she could not reapply for six months, until April 30, 2008.

One problem with this missive was the premium was paid, well within the prescribed period. Ochs has a stub and receipt from her $75 money order to prove it. Her payment was apparently lost in the mail or by the state.

After a series of panicked calls, Ochs got the state to agree to an extension. She'll be able to stay on the program, and can eventually recover all but $12 from the uncashed money order.

But Ochs is angry about the experience. She doesn't understand why the state won't let her pay her BadgerCare premium online, using a credit card, which would have prevented this problem. She notes that if she did not work, she would not be charged a premium and thus would not be subject to revocation should the state lose her payment.

"What they're doing is a disincentive for me to stay on the job," she says.

Finally, Ochs thinks it's "ridiculous" that the state's response to a missed payment - even if it were due to a parent's negligence - is a six-month termination of coverage. "A half a year for a child to not have insurance?" she asks. "Their policies need to change."

Jason Helgerson, state Medicaid director, says about 15% of BadgerCare clients pay a monthly premium, calculated at 5% of their family income. Currently, premiums are charged to families that make at least 150% of the federal poverty level. Starting Feb. 1, when BadgerCare will merge with two other programs to become BadgerCare Plus, the threshold will rise to 200% for children and the amount charged will be calculated on a sliding scale.

Helgerson says the state allows people to pay through wage withholding and automatic bank withdrawals. And it hopes a Web redesign will allow the use of credit cards. "We want to make it as easy as possible for people to pay."

He adds that terminating people who miss payments is similar to what would happen with any health-care plan: "If you don't pay the premium, you lose the benefits." But barring reenrollment for six months serves two purposes particular to BadgerCare. It prevents people from signing up only when they're sick and "provides some incentive for people to make their payments." BadgerCare Plus will retain this six-month ban on reenrollment.

Dane County's Heidt, speaking in general, says the "state does create a climate where BadgerCare workers are forced to oververify information." He adds that clients can be cut off for "things totally out of their hands," like when employers fail to promptly verify their lack of health insurance.

Ochs sums it up differently: "A 10-year-old child does not know what a premium is. He just knows when he can't go to a doctor."

Legal discrimination

Dane County Judge Sarah O'Brien last week imposed sanctions on Madison attorney David Sparer, ruling that part of his representation of a tenant whose lease was not renewed after starting a neighborhood watch was "frivolous." She ordered Sparer to pay one-third of the attorney fees incurred by the defendant, Wisconsin Management Company, likely several thousand dollars.

The company denied having retaliated against Sparer's client, but argued that even if it had, there was no law protecting those who formed a neighborhood watch. In response, Sparer helped spearhead a change in Madison law to specifically cover this activity (see "Law Change Too Late for Lawyer," 10/19/07).

O'Brien's ruling, which Sparer is weighing whether to appeal, agreed that some of his arguments had a basis in law. But she rejected his claim that forming a neighborhood watch was protected under Madison law as it then existed, calling an amicus brief from the Madison City Attorney's Office in support of this "ridiculous."

Also specifically rejected was Sparer's claim that his client's lease renewed automatically. Ironically, in a separate case, Sparer is representing Madison Community Cooperative in defending against a former co-op member making a similar claim.

The former member, Bill Anderson, was not renewed at an MCC property in August. Anderson has lodged a complaint against the co-op with the Madison Equal Opportunities Commission, alleging he was discriminated against on the basis of his political beliefs and co-op-related activism.

Sparer, in a filing with the EOC, says Anderson got the boot because of his "threatening behavior." He goes on to explain that the ban on retaliation is not absolute.

"For example," writes Sparer, "a tenant who repeatedly insults the landlord's appearance is not protected from having the landlord retaliate by refusing to renew that tenant's lease." Ditto for a tenant who repeatedly quarrels with a landlord over "the best flavor of ice cream."

Finally, Sparer drops this bombshell, to show the narrowness of the definition of "political beliefs": "A tenant who is a very ardent Chicago Bears fan could be non-renewed by his landlord who is a hugely loyal Green Bay Packers fan."

That's one loophole the Common Council probably isn't going to be in a hurry to plug.

Not fit to print

The other day, Wisconsin State Journal columnist Susan Lampert Smith penned a typically excellent column about the lackadaisical response of local authorities to UW students trying to sound an alarm about a roommate having an apparent mental breakdown. They even posted blog entries about how people would soon be dying.

Ultimately, measures were taken to intervene, but it wasn't easy. One student was quoted saying, "It was like calling...trying to get your cable fixed."

Dot, dot, dot? Doesn't it read like what's missing from this sentence, replaced by ellipses, is a company name, as in, "It was like calling Charter, trying to get your cable fixed"?

Smith confirms this is what the student said, but that another reporter who edited the piece found it gratuitous and advised taking it out. She didn't object: "The story wasn't really about Charter. It was just an amusing quote that summed up their frustration."

If only the folks at Charter were this considerate....

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