With phenomenal enrollment figures in Wisconsin’s BadgerCare Program, the State is currently grappling with how to ensure a balance between the public Medicaid expansion program and employer-provided health insurance. For BadgerCare, verifying access to employer-provided family health insurance is key to creating this balance, but becomes difficult due to state interference in employee health benefit programs that are governed by ERISA. Outside of an ERISA amendment allowing states to require employers to submit health information to state Medicaid expansion programs and coordinate with buy-in options, one could argue that states such as Wisconsin may already be able to access employee health benefit information through two current ERISA preemption exceptions concerning Title XIX and Qualified Medical Child Support Orders (QMCSOs). Using BadgerCare as an example, this article illustrates how these two ERISA preemption exceptions would likely give states legal ammunition to require employers to provide employee health benefit information to the state and cooperate with state efforts to coordinate public and private health insurance programs. However, practical application of these ERISA exceptions would also require greater collaboration between various state and federal agencies. Thus, legislative support is necessary to encourage more seamless systems of detecting whether enrollees in Medicaid expansion programs have access to employee health benefits. Increased access to employer-provided health benefit information would be invaluable to state governments; the efficient operation of Medicaid expansion programs relies heavily on the continuing strength of private employer systems in order to avoid crowd out and preserve state fiscal integrity.
Learning Objectives: At the conclusion of the session, the participant in this session will be able to: 1. Articulate the importance of employer health insurance programs to Medicaid expansion programs, such as the Wisconsin BadgerCare program. 2. List two possible ERISA preemption exceptions to state involvement in employer benefit plans. 3. Construct a legal argument for states to require employers to provide health benefit information for purposes of Medicaid expansion programs and coordinate with state buy-in options.
Keywords: Medicaid, Employer-Provided Health Insurance
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.