I had a CT scan last Wednesday and normally the Doctor calls the next day with the results, my follow up appointment is Friday, so it's either good news or it's news he needs to tell me face to face. I'll be honest, I'm worried. I have been feeling queasy since April and I'm easily fatigued and winded. These are the beginning signs that the disease it is progressing. It's been 1 1/2 years since the first surgery, so I'm close to needing surgery again. I have mixed feelings about this, if surgery is needed sooner than later, it might be a good thing, if it happens later, the new rules that Dennis Smith will put into place may end up denying or limiting me the care I need. I'd prefer to hold off for as long as possible, I think it's terrible that I should even have to make these considerations.
So I'm not only waiting for the Doctors results, I'm waiting for the results that will take place from Dennis Smith's newly granted authority to make changes to medicaid without being responsible to the people of Wisconsin. Instead of focusing on my health and well being, I have waste time following what Walker and Smith are doing to Medicaid. I'm sure the 'unspecified changes to medicaid' will become quickly apparent once the budget finance committee has completed it's work and it moves through the Senate and on for Walker to sign.
Today, I am going to go outside and enjoy the sunshine and warm weather before the storms roll in and take my mind off of this for awhile. I'll post later this week what my results are, here's hoping I have more time to accomplish some of the more important things I need to do before the next surgery.
Tuesday, May 31, 2011
Friday, May 27, 2011
BadgerCare is a lifeline for many
As a BadgerCare recipient - and the mother of three children who have BadgerCare to thank for their good health, I have followed with great interest Gov. Scott Walker's proposal to cut $500 million from the program over the next two years. These cuts will have a real and lasting impact on families across the state, starting with mine.
Every day, I thank God for BadgerCare, for the prenatal care it provided me throughout each of my three pregnancies, for the regular check-ups that ensure my children stay healthy and strong and for the medicine we get when we are sick.Because of BadgerCare, two of my children who suffer from chronic asthma - 6-year-old Genesis and 21-month-old Isaac - receive the inhalers, medicine and doctor visits they need to breathe clearly.
Because of BadgerCare, my husband - who has not had access to employer-sponsored insurance in two long years - is able to receive regular medical care, from routine check-ups and preventive care to emergency treatment for injuries sustained on the job.
BadgerCare was designed to protect Wisconsin's working families during times of high unemployment. Thankfully, my husband is working. But like many Wisconsinites, he has endured stretches of unemployment during this recession. BadgerCare has been a lifeline for us during these gaps, ensuring consistent health care so that when a job became available, he was ready and able to take it.
As our leaders in Madison consider the future of BadgerCare, it's important that they:
Don't throw working parents overboard. Parents in families of three or four both working minimum-wage jobs would be disqualified from BadgerCare under this budget plan - as many as 63,000 working parents in all. And low-wage workers offered employer-sponsored - but often unaffordable - insurance would likewise be dropped, leading to greater numbers of uninsured.
Don't reduce important benefits or eligibility requirements. Tough economic times are precisely when we should be investing in cost-effective programs like BadgerCare, not limiting its care. This program has helped us weather the storm, and with unemployment still high, many of us continue to rely on it. This is especially important for eligible non-parental adults who make up the Core Plan. I have a very close friend, a certified teacher unable to find work, who relies on BadgerCare for access to care. If he is forced out of BadgerCare, his only recourse for care will be costly emergency room visits.
Protect BadgerCare's affordability by keeping out-of-pocket costs low. Right now, my husband and I can afford our co-pays for doctor visits and prescriptions. However, any increase to out-of-pocket costs would severely compromise our ability to maintain regular check-ups and afford much-needed medicine, effectively rendering us uninsured.
Even small gaps in coverage can be catastrophic. Three years ago, my family temporarily lost our coverage, during which time Genesis came down with a cough. A doctor refused to see us for lack of insurance and ability to pay, and we couldn't afford to fill a prescription we received after visiting an emergency room. Genesis got sicker and sicker, and the cough became bronchitis.
It was not until our coverage was reinstated that we could get the prescription filled. Meanwhile, Genesis suffered for four months.
BadgerCare keeps us healthy, but it does more than that: It gives us hope for a better life. Because BadgerCare covers my family's health care costs, I'm able to take classes online to become an accountant while at the same time caring for my two youngest children. My hope once my children are old enough to begin school is to get a job that will provide me with private health insurance. But if we lose our BadgerCare coverage, I'll have to quit school and work full time at a job that might not provide insurance coverage in order to pay for health care for my family.
BadgerCare was created to provide low-income families like mine with access to quality, affordable health care.
Let's keep it that way.
This Link Is Worth Reading
Medicaid, the Budget, and Deficit Reduction: Keeping Score of the Threats.
From Families USA • May 2011: http://familiesusa2.org/assets/pdfs/Threats-to-Medicaid.pdf
The Truth-O-Meter Says:
One of every two Wisconsin residents are "on some kind of government handout."
Scott Fitzgerald on Saturday, May 21st, 2011 in a speech at the state GOP conventionWisconsin Senate Majority Leader Scott Fitzgerald says half of state residents are “on some kind of government handout”
http://www.politifact.com/wisconsin/statements/2011/may/26/scott-fitzgerald/wisconsin-senate-majority-leader-scott-fitzgerald-/ Addressing the Wisconsin Republican Party’s annual convention on May 21, 2011, state Senate Majority Leader Scott Fitzgerald, R-Juneau, reflected on the transformational 2010 elections. The GOP swept to power, taking from Democrats the governor’s office as well as control of the Senate and Assembly.
"That election needed to happen. Our country is facing challenges we simply can’t ignore," Fitzgerald told hundreds of convention-goers at a Wisconsin Dells resort.
"Our government is growing too fast, too big; it’s becoming too expensive. One out of every five people in Wisconsin are on Medicaid or Medicare. One out of every two are on some kind of government handout."
One out of every two people in Wisconsin -- half the state’s residents -- receive a "government handout?"
That’s a lot of Wisconsinites.
We asked Fitzgerald’s spokesman, Andrew Welhouse, for evidence to back up the statement. Welhouse initially said his boss’ claim "looks wrong, but the larger conversation about entitlements and government spending is long overdue."
That’s not much of a defense.
Welhouse did cite this passage from an April 2011 analysis of federal data done by USA Today:
"A record 18.3 percent of the nation's total personal income was a payment from the government for Social Security, Medicare, food stamps, unemployment benefits and other programs in 2010. Wages accounted for the lowest share of income — 51 percent — since the government began keeping track in 1929."
That all may be true. But it’s off point.
The article indicates what percentage of Americans’ overall income comes from the government. But it says nothing about what percentage of individual Wisconsinites -- or Americans, for that matter -- receive government assistance.
We told Welhouse we still wanted to know what Fitzgerald defined as government handouts. When he called back, he said Fitzgerald told him he had meant to say that one in six Wisconsin residents -- not one in two -- get government handouts.
Welhouse didn’t say what Fitzgerald considered as handouts, but he provided another USA Today article, from August 2010. Analyzing state data, the newspaper found that government anti-poverty programs such as welfare, Medicaid, food stamps and unemployment insurance served a record one in six Americans.
The article makes no mention of Wisconsin, however.
We contacted state agencies to see how many Wisconsinites receive government assistance from the four major programs cited in the second article that Welhouse provided. Here’s what we found:
Since Wisconsin has about 5.65 million people, according to the U.S. Census Bureau, that means roughly one in five state residents is on Medicaid alone.
If you added the recipients in all four programs, the total would represent 2.16 million people, or more than one in three Wisconsinites. That would still be far short of the one in two that Fitzgerald claimed at the convention.
But the true figure is lower than 2.16 million because some people receive assistance from more than one of the programs. Based on the available information, we could not determine an exact number – nor could Fitzgerald.
We also contacted experts at four private organizations in Wisconsin that track government programs. None said they were aware of any study that attempted to determine what percentage of Wisconsin residents receives government assistance or a "government handout."
All of this is setting aside the question of what constitutes a handout, which is a subjective term.
The article cited by Fitzgerald’s aide to support the 1-in-2 claim included Social Security and Medicare, both of which workers pay into through payroll taxes. Many people would not consider those programs handouts.
Here’s the bottom line:
Fitzgerald made a bold statement at the state GOP convention -- that one out of every two Wisconsin residents "is on some kind of government handout." He was able to provide no evidence to back the claim, and even one of his aides essentially acknowledged it was wrong. The Senate leader later provided a different number, but the data he relied on is not specific to Wisconsin.
We rate Fitzgerald’s statement False.
"That election needed to happen. Our country is facing challenges we simply can’t ignore," Fitzgerald told hundreds of convention-goers at a Wisconsin Dells resort.
"Our government is growing too fast, too big; it’s becoming too expensive. One out of every five people in Wisconsin are on Medicaid or Medicare. One out of every two are on some kind of government handout."
One out of every two people in Wisconsin -- half the state’s residents -- receive a "government handout?"
That’s a lot of Wisconsinites.
We asked Fitzgerald’s spokesman, Andrew Welhouse, for evidence to back up the statement. Welhouse initially said his boss’ claim "looks wrong, but the larger conversation about entitlements and government spending is long overdue."
That’s not much of a defense.
Welhouse did cite this passage from an April 2011 analysis of federal data done by USA Today:
"A record 18.3 percent of the nation's total personal income was a payment from the government for Social Security, Medicare, food stamps, unemployment benefits and other programs in 2010. Wages accounted for the lowest share of income — 51 percent — since the government began keeping track in 1929."
That all may be true. But it’s off point.
The article indicates what percentage of Americans’ overall income comes from the government. But it says nothing about what percentage of individual Wisconsinites -- or Americans, for that matter -- receive government assistance.
We told Welhouse we still wanted to know what Fitzgerald defined as government handouts. When he called back, he said Fitzgerald told him he had meant to say that one in six Wisconsin residents -- not one in two -- get government handouts.
Welhouse didn’t say what Fitzgerald considered as handouts, but he provided another USA Today article, from August 2010. Analyzing state data, the newspaper found that government anti-poverty programs such as welfare, Medicaid, food stamps and unemployment insurance served a record one in six Americans.
The article makes no mention of Wisconsin, however.
We contacted state agencies to see how many Wisconsinites receive government assistance from the four major programs cited in the second article that Welhouse provided. Here’s what we found:
- Medicaid: 1,174,874 people, including more than 465,000 children, receive Medicaid, according to the Wisconsin Department of Health Services. Medicaid, including the state’s BadgerCare programs, pays for health care for low-income people.
- Food stamps: 802,979 people, including 353,310 children, were in the FoodShare program as of March 2011, according to the same department.
- Unemployment insurance: 140,055 people are on unemployment, according to the Wisconsin Department of Workforce Development.
- Wisconsin Works (W-2), which replaced traditional welfare: 43,093 people, including 27,614 children, were receiving W-2 cash assistance as of April 2011, according to the Wisconsin Department of Children & Families.
Since Wisconsin has about 5.65 million people, according to the U.S. Census Bureau, that means roughly one in five state residents is on Medicaid alone.
If you added the recipients in all four programs, the total would represent 2.16 million people, or more than one in three Wisconsinites. That would still be far short of the one in two that Fitzgerald claimed at the convention.
But the true figure is lower than 2.16 million because some people receive assistance from more than one of the programs. Based on the available information, we could not determine an exact number – nor could Fitzgerald.
We also contacted experts at four private organizations in Wisconsin that track government programs. None said they were aware of any study that attempted to determine what percentage of Wisconsin residents receives government assistance or a "government handout."
All of this is setting aside the question of what constitutes a handout, which is a subjective term.
The article cited by Fitzgerald’s aide to support the 1-in-2 claim included Social Security and Medicare, both of which workers pay into through payroll taxes. Many people would not consider those programs handouts.
Here’s the bottom line:
Fitzgerald made a bold statement at the state GOP convention -- that one out of every two Wisconsin residents "is on some kind of government handout." He was able to provide no evidence to back the claim, and even one of his aides essentially acknowledged it was wrong. The Senate leader later provided a different number, but the data he relied on is not specific to Wisconsin.
We rate Fitzgerald’s statement False.
Thursday, May 26, 2011
From Cudahy Now.Com
Press Release in Regards to Caps on Family Care
Here is a press release in regards to the Joint Committee of Finance Action on Medical Assistance, Family Care and SeniorCare. Having spent a significant amount of time on this issue, it was very dishearting to hear that there will be a cap on Family Care.On Tuesday the Joint Finance Committee voted to freeze all long-term care programs in
Wisconsin, impacting thousands of seniors and people with disabilities. In taking this action, the
committee ignored the calls, e-mails, petitions and personal stories of countless Wisconsin
residents. In addition to denying the needs of over 9,000 adults on Family Care and IRIS waiting
lists and more than 3,000 children on Children’s Waiver waiting lists, this decision signals a total
loss of momentum in the state’s 15-year effort to reform the long-term care system.
Although we appreciate the committee’s modest gesture to allocate $5 million annually in state
funds for Family Care services to individuals in urgent need of long-term care services, this will
only serve 400 people per year. Based on the thousands of adults and children currently on wait
lists and a possible doubling of wait lists during the two-year freeze, this allocation will not
provide much relief.
Advocates predict the new funds will not even support the total number of individuals estimated
to be forced into nursing homes over the biennium as a result of the freeze. The state assumes
that 5% of prospective Family Care enrollees, without access to community care, will be forced
into nursing homes between now and June, 2013—an estimated 484 individuals at a total cost of
over $30 million. Advocates believe these projections are low—Milwaukee County predicts that
300 people in that county alone will be forced into nursing homes each year. Although it did not
commit any additional funding, the Committee endorsed a proposal to add flexibility to the
budget bill – allowing some individuals relocating from a nursing home to enroll in community
long-term care.
Advocates had hoped legislators would prioritize community long-term care, like many previous
legislatures have for decades, and choose to commit a minimum of 10 percent of the $636
million in newly projected state revenues to stop the growth of wait lists. Unfortunately a
motion to do that failed on a party line vote of 12-4.
The Committee’s decision to freeze all long-term care programs, except nursing homes, will
seriously undermine the cost effectiveness of the state’s long-term care system. The only
entitlement the committee left intact is a right to live in an institution. The average cost of Family
Care is $2,800 per month versus the average nursing home cost of $4,000. Costs in other
institutional settings range from $16,500 to $40,920 a month. Now Wisconsin’s average cost oflong-term care will climb back up in national rankings, reversing the trend of the last decade that
saved taxpayer dollars.
In another Medicaid-related vote, the Committee took the advice of advocates and people with
disabilities and is requiring some transparency in the Medicaid decision-making process as the
Department of Health Services finds $500 million in savings. DHS will be required to submit
quarterly reports to the Committee that contain descriptions of any MA program changes
implemented by the Department, updated estimates of the projected savings associated with
those changes; and updated projections of total MA benefit expenditures during the biennium.
DHS must also submit any federal Medicaid waiver or state plan amendment requests to the
committee in a passive review process. This does not guarantee a Committee vote on any
proposed DHS change.
Read a full report on Wisconsin Community Long-Term Care here: Keeping the Community Promise – Lifting the Cap on Long-Term Care in Wisconsin. http://www.disabilityrightswi.org/wp-content/uploads/2011/05/Keeping-the-Community- Promise.pdf
Drastic Cuts To Medicaid
May 25, 2011
Media Contact: Bob Jacobson
Save BadgerCare Statement on Joint Finance Committee’s Medicaid Vote
Drastic Cuts with Limited Legislative Oversight Will Lead to More Uninsured Wisconsinites
The Save BadgerCare Coalition was extremely disappointed by the Joint Finance Committee’s vote Tuesday evening to clear the way for devastating cuts to Medicaid and BadgerCare Plus, which will be made by the Department of Health Services (DHS) with little legislative oversight.
The Committee approved $466 million in unspecified cuts to Wisconsin’s Medicaid programs. While the exact nature of the cuts remains unknown, they will almost certainly make it harder for people to enroll and stay in these programs, resulting in a dramatic increase in the number of uninsured people in the state.
One of the anticipated outcome of this vote includes increased BadgerCare premiums, which a new analysis by Georgetown University’s Center on Children and Families has shown will result in tens of thousands of people losing their coverage. Other likely changes include higher copays, more restrictions on the range of services covered, and more red tape for applicants and existing participants. All of these changes will result in people losing coverage.
The Save BadgerCare Coalition has urged legislators not to abdicate their responsibility for deciding which Wisconsin children and families will be able to count on Medicaid and BadgerCare Plus. Unfortunately, the Committee agreed to allow DHS to make unspecified cuts and policy changes—including changes that supersede state statutes-- with minimal oversight from the Joint Finance Committee. The full legislature will be shut out of the process entirely.
In addition to the negative impact on the health of Wisconsin’s kids and families, a sharp increase in uninsured people will result in increased use of expensive emergency services, force hospitals to provide more uncompensated care, and consequently drive up the cost of health care for everybody.
The Save BadgerCare Coalition consists of health care providers, public policy experts, aging advocacy groups, disability rights advocates, consumers and the faith community working together to sustain Medicaid and BadgerCare and to ensure health insurance for Wisconsin families. For more information regarding the Save BadgerCare Coalition visit www.savebadgercare.org.
Ken Taylor column: Who should make Medicaid policy decisions?
Lawmakers will get a second chance this spring to answer an extremely important question: Should the laws that determine which children and families get the health care they need be written by the men and women we send to Madison to represent us, or by an unelected state administrator?What's at stake is who will have the power and responsibility to decide which Wisconsin kids and families will be able to count on Medicaid and BadgerCare Plus, and whether the decision maker(s) will be accountable to Wisconsin voters. If the governor's budget takes effect, Wisconsin will cut more than $1 billion from health care during the next two years, yet the budget is largely silent on how the health care cuts will be made or who will feel the pain.
That's because the budget repair bill lets lawmakers escape accountability for those decisions, by shifting responsibility for critical policy choices to the head of the Department of Health Services. That legislation gives the DHS secretary sweeping power to change the law on who is eligible for health coverage, what care they get and what care they're denied, and how much they will have to pay.
Because the budget repair bill gives the DHS secretary nearly boundless power and cuts legislators out of the process, the budget bill doesn't shed any light on how the cost-cutting will be achieved. The Walker administration has hinted at some of the changes they will make but has not provided any details.
Informed observers expect that DHS will propose restrictions that will result in a large increase in the number of uninsured Wisconsinites. That means moving away from cost-effective preventive care, increased costs as newly uninsured kids and families are forced to rely on expensive emergency room care and higher premiums for families and small businesses, as doctors and hospitals shift costs for uncompensated care to patients with private insurance.
If nothing changes, legislators won't have to approve the policy changes, and they won't have to insist that the secretary explain how the cost-savings will be achieved. That means voters like you and me lose our right to participate in an informed debate about the consequences of the agency's plans and alternative options to balance the budget.
Because the budget repair bill is stalled in the courts, legislators likely will have to vote again on who is responsible for writing our state's health care laws. They should take advantage of that opportunity to make a better, more responsible, more accountable decision.
No one man or woman should be trusted with unchecked power, especially over something as important as the health of Wisconsin children and families. Our lawmakers should fulfill their responsibility to make Wisconsin's laws. At the very least, legislators should require that any rules proposed by DHS that conflict with state statutes have to be approved by the full Legislature.
The governor's proposal puts the health care of more than 1 million Wisconsinites at risk, and it threatens to roll back more than a decade of successful bipartisan efforts to reduce the number of uninsured Wisconsinites. If legislators give up their authority for writing state health care laws, Wisconsin's democracy will be weakened. In effect, the Legislature will be stripping our rights as citizens to hold policymakers accountable for decisions that affect us. The men and women we elect to represent us in the Legislature should not abdicate their law-making responsibilities.
Wednesday, May 25, 2011
Family Care Put On Hold/Medicaid Cuts
Budget panel rejects changes to SeniorCare
Approves $466M in cuts to Medicaid programs
Written by Scott Bauer
MADISON — Wisconsin's popular prescription drug program for senior citizens will remain the same under a plan approved Tuesday by the Legislature's budget committee, which rejected proposed changes to the program sought by Gov. Scott Walker.There was bipartisan support to keep the popular SeniorCare program unchanged, though the Republican-controlled Joint Finance Committee did agree to cap enrollment for the next two years for Family Care, a program designed to keep people out of nursing homes. Committee members also agreed to make about $466 million in unspecified cuts to other Medicaid programs.
"SeniorCare is the holy grail of public policy," said Sen. Bob Jauch, D-Poplar.
The plan must be approved by the Republican-controlled Legislature and signed by Walker before taking effect.
In his two-year budget plan, Walker wanted to require SeniorCare enrollees to first sign up for the Medicare Part D prescription drug program and use state benefits under SeniorCare as a supplement. That would have saved $15 million over the next two years.
Supporters of the 10-year-old SeniorCare program, which has a history of bipartisan support, said the state program is both less expensive and easier to enroll in and understand than Medicare Part D.
SeniorCare serves about 91,000 residents older than 65, but only 12,000 are also currently enrolled in Medicare Part D. Enrollees are required to pay an annual $30 fee and deductibles based on their average income. After the deductible, the program has a co-pay of $5 for generic drugs and $15 for brand-name drugs.
Medicare Part D costs vary depending on insurance providers, but the average premium cost for Wisconsin plans is $44 a month.
Democrats rallied against Walker's proposed changes to the program, and presented petitions that they said contained 14,000 signatures in support of keeping the program as is. Republican leaders quickly said they also didn't support the governor's changes.
However, the committee did agree with Walker's proposal to cap enrollment in Family Care, a program that provides long-term care options for low-income adults who have developmental or physical disabilities or are frail and elderly. Services currently offered to enrollees wouldn't change and no one in the program now would be kicked out.
Democrats argued that it made more sense to invest in the program to keep people out of nursing homes and other services that cost more than Family Care.
But Republicans argued that Family Care was rapidly growing — it cost $250 million in 2006, but expected to cost $1.4 billion in each of the next two years — and must be put on hold.
How Family Care Played Out
This is what I observed during the joint finance committee hearing.
Jauch asked the finance bureau how much Walker planned for nursing homes in the budget, it was $4,000 a month, per person, they expect to spend 36 million, I believe it would for three years under the proposed budget. 36 million is already in this budget, to as Jauch said 'to warehouse' instead of letting them stay in their homes, which saves money! This is contrary to Dennis Smiths comments about wanting people to self direct their care including staying at home with their families. This also shows we are not broke. Tamara Grigsby said this: "we are judged by how we treat our most vulnerable." Instead of offering peace of mind to the most vulnerable, the Republicans offer institutionalized care.The Republicans push to privatize everything is coming into clear view and the effects it will have on the State will be dramatic and I fear, traumatizing.
Tuesday, May 24, 2011
From Sara Finger
Tuesday, May 24, 2011
6:21 PMCommittee takes up MA omnibus
Among the provisions:
- Adopts alternative 1 from budget paper 340. Increase funding in the bill by $45.4 million in 2011-12 and $53.2 million in 2012-13 to reflect funding adjustments summarized in discussion point 16 of the LFB paper. In addition, revise statutory provisions relating to the UW lapse to the MA trust fund to reduce the annual lapse amounts in 2011-12 and 2012-13 from $27.5 million to an amount up to $20.3 million annually.
Also, adopt alternative 2 with a modification. Increase funding in teh bill by $15.5 million in 2011-12 and $40.5 million in 2012-13 to reflect revised enrollment growth projections.
Also, delete the provision in the bill that would require DHS to lapse $25 million in the first year of the biennium.
- Adopt alternative 1 in budget paper 341, which would adopt Gov. Walker's proposal to reduce funding for the MA program by $133.3 million in 2011-12 and by $333.3 million in 2012-13 to reflect the administration's estimate of the savings achieved by making various unspecified changes to the MA program.
In addition, adopt alternative 2b from the LFB paper which would require DHS to submit quarterly reports to the JFC containing: updated descriptions of any MA changes implemented by DHS; updated estimates of the projected savings from those changes; and updated projections of the total MA benefit expenditure during the biennium and an analysis of how the expenditures compare with the funding provided.
- Adopt alternatives A1, B1, C1, and D1 in budget paper 342. The motion would prohibit DHS from enrolling more people into Family Care, Family Care Partnership, PACE or IRIS programs than the total number of persons participating in all of those programs in that ADRC region on June 30, or the effective date of the bill, whichever is later. DHS could only enroll people in the long-term care programs that are offered in that person's county of residence.
The enrollment cap would not apply after June 30, 2013. The months when the provision is in effect would nto be counted toward a person's statutory requirement that DHS have sufficient capacity to offer the Family Care benefit to all entitled people after the first three years the benefit is available in a county.
DHS could enroll any individual into the Family Care-related programs who is relocated from a nursing home, intermediate care facility for the mentally retarded, or State Center for People with Developmental Disabilities if the individual has resided in the facility for at least 90 days, the facility is not licensed, an emergency exists or the facility is closing or downsizing.
In addition, DHS is required to do a cost-effectiveness study of the programs compared to one another and to standard MA card services. The findings must be presented to the JFC by March 1, 2012.
Under the motion, care management organizations that provide the Family Care benefit are prohibited from including in their contracts with providers any provision that would require providers to return funding in excess of the cots of service to the CMO.
Also, provide $12.6 million in 2011-12 and $12.6 million in 2012-13 to fund Family Care services to individuals on waitlists who are in urgent need of long-term services, as determined by DHS. The funds must specifically be used to serve individuals on a temporary basis until the individual is permanently enrolled in the program.
- On budget paper 343, increase funding for SeniorCare by $6.8 million in 2011-12 and by $3.3 million in 2012-13 to reflect a reestimate of the costs to fully fund the program, based on current law.
- Adopt alternative 5 from budget paper 344, which would eliminate the governor's proposal to require SeniorCare participants to enroll in Medicare Part D.
- Adopt alternative 1 from budget paper 345, adopting Walker's proposal to institute a Medicare Part A cutback. Reduce funding in the bill by $1.7 million in 2011-12 and $2.4 million in 2012-13.
- Delete the governor's recommendation in budget paper 346 to eliminate base funding for the EACH payment and to repeal statutory provisions relating to this payment. Increase funding in the bill by $4.3 million in 2011-12 and $4.3 million in 2012-13 to support supplemental payments to hospitals.
- Adopt alternative A3 in budget paper 348, which would increase funding in the bill by $465,700 GPR and $713,700 FED in 2011-12 and by $468,100 GPR and $711,300 FED in 2012-13, so that $39.1 million would be budgeted for supplemental payments to municipal nursing homes annually.
- Orders DHS to study whether using competitive bidding for the purchase of generic drug equivalents provided to MA recipients would generate savings. A report is due to the JFC by Dec. 31.
-- Prohibit DHS from requiring prior authorization for wheelchair repairs that cost less than $300 for power wheelchairs and $150 for manual models. The provision would apply to all MA-related programs.
- Require DHS to seek approval from the Centers for Medicare and Medicaid Services that would permit friends and family of individuals enrolled in MA to contribute to the individual's burial trust, up to a limit of $4,500, without the individual losing eligibility in the MA program.
- Repeal provisions from 2011 Act 10 authorizing DHS to promulgate rules to implement MA program changes that conflict with the specific statutory sections identified in the Act 10.
Instead, establish a passive review process for any changes to the MA program that would otherwise be in conflict with statutory sections specifically identified in Act. 10.
- On budget paper 347, adopt modification to reduce funding by $532,600 in 2011-12 and $607,800 in 2012-13 to reflect revised estimates of project payments to Wisconsin Physician's Services, based on a reestimate of the number of children who will be enrolled in the CLTS and Birth-to-3 programs.
We Are Screwed!
Watching the JFC and they are pushing the Walker Admin. agenda with no hesitation or reservation. The Democrats are passionately fighting for us and they are being voted down on the items discussed so far. Have not gotten to M.S yet. I'll keep posting as it goes along or follow along at: http://www.wiseye.com/Home/AirVideoStream.aspx.
Update 8:00 p.m
This was horrible! To watch the Democrats be ignored and set up for 'gotcha' moments, which were debunked and the rude name calling by Kleefisch was out of line and unprofessional. I was happy to hear Jauch, Taylor, Schilling, Grigsby ask purposeful questions and ask for clarification from the fiscal bureau, they were able to smack down a pompous question from Alberta Darling. I loved it! It's now on record that Walker wanted to give Dennis Smith unbridled authority to make changes without public or legislative input.
Kleefisch was severely offended that it was implied that he didn't care about the disabled. He bragged about a plaque on his wall that he received for participating in an event for the disabled, he is the biggest hypocrite of all. I zeroed in him during this hearing because of his body language, at one point he was slumped in his chair with his arms hanging down, looking bored and rolling his eyes. The only time he perked up was to make snide and rude comments. Grotham was another one that annoyed me, you might remember him as the one that called the protesters 'slobs'.
At the end of this hearing something interesting happened, when the Democrats asked for two provisions to be removed from the amendment, the Republicans quickly shut down the conversation and took a vote. Schillings response to the Republicans was 'rules don't matter'. Apparently this is how they handle things now, end the conversation when things don't go their way. They also chimed in with the usual buzz words and aspects of the budget that they feel they own, such as workers rights, the new voting law, medicaid and budget cuts to schools. There was also a phrase they used over and over, it was: 'we need to take a pause'. To me, to take a pause, will mean people will die. There are 9,000 people on a waiting list and the only thing the Republicans had to offer was a 400 crisis slots that the H.S would some cases decide you gets the slots. There is so much to go over, but I'll wait until I get clarification.
I don't think they covered all of the provisions in this hearing, I'll post the summary from the advocacy groups when I get it. Some of the conversation was over my head, I was able understood quite a bit of it though. This is very sad and I highly recommend you watch some of the coverage, you need to see for yourself what's going on. I'll keep you posted as I receive more information. All I can say is.... people you need to follow along on this issue, they will destroy medicaid if they are allowed. Really... you need to watch at least part of this hearing on Wisconsin eye.
Update 8:00 p.m
This was horrible! To watch the Democrats be ignored and set up for 'gotcha' moments, which were debunked and the rude name calling by Kleefisch was out of line and unprofessional. I was happy to hear Jauch, Taylor, Schilling, Grigsby ask purposeful questions and ask for clarification from the fiscal bureau, they were able to smack down a pompous question from Alberta Darling. I loved it! It's now on record that Walker wanted to give Dennis Smith unbridled authority to make changes without public or legislative input.
Kleefisch was severely offended that it was implied that he didn't care about the disabled. He bragged about a plaque on his wall that he received for participating in an event for the disabled, he is the biggest hypocrite of all. I zeroed in him during this hearing because of his body language, at one point he was slumped in his chair with his arms hanging down, looking bored and rolling his eyes. The only time he perked up was to make snide and rude comments. Grotham was another one that annoyed me, you might remember him as the one that called the protesters 'slobs'.
At the end of this hearing something interesting happened, when the Democrats asked for two provisions to be removed from the amendment, the Republicans quickly shut down the conversation and took a vote. Schillings response to the Republicans was 'rules don't matter'. Apparently this is how they handle things now, end the conversation when things don't go their way. They also chimed in with the usual buzz words and aspects of the budget that they feel they own, such as workers rights, the new voting law, medicaid and budget cuts to schools. There was also a phrase they used over and over, it was: 'we need to take a pause'. To me, to take a pause, will mean people will die. There are 9,000 people on a waiting list and the only thing the Republicans had to offer was a 400 crisis slots that the H.S would some cases decide you gets the slots. There is so much to go over, but I'll wait until I get clarification.
I don't think they covered all of the provisions in this hearing, I'll post the summary from the advocacy groups when I get it. Some of the conversation was over my head, I was able understood quite a bit of it though. This is very sad and I highly recommend you watch some of the coverage, you need to see for yourself what's going on. I'll keep you posted as I receive more information. All I can say is.... people you need to follow along on this issue, they will destroy medicaid if they are allowed. Really... you need to watch at least part of this hearing on Wisconsin eye.
Monday, May 23, 2011
What The JFC Will Be Discussing Tuesday
From Sara Finger
Sara Finger: sara.finger@wiawh.org
Link to the papers: http://legis.wisconsin.gov/lfb/2011-13%20Budget/Budget%20Papers/May%2024.htm.
Sara Finger: sara.finger@wiawh.org
Link to the papers: http://legis.wisconsin.gov/lfb/2011-13%20Budget/Budget%20Papers/May%2024.htm.
Here's the Legislative Fiscal Bureau papers on Medicaid to be taken up for discussion by the Joint Finance Committee next Tuesday.
340 Medical Assistance -- Base Reestimate
341 Unspecified Program Changes to Medical Assistance
342 Family Care Enrollment Cap
343 SeniorCare Base Reestimate
344 Require SeniorCare Participants to Enroll in Medicare Part D
345 Medical Assistance Payments for Medicare Part A Services
346 Essential Access City Hospital Payments
347 Third Party Administrator -- County Payments
348 Supplemental Payments to Municipal Nursing Homes
Sunday, May 22, 2011
Last Chance To Contact Your Legislator
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Go to this website and click on the link on the right hand side of the page:
Urge Your Legislators to Support BadgerCare! http://www.savebadgercare.org/
Saturday, May 21, 2011
The People Push Back
The People Push Back
This is a great story, I hope more will follow this example.
http://www.huffingtonpost.com/2011/05/17/nurses-layoffs-executives-attack_n_862741.html
This is a great story, I hope more will follow this example.
http://www.huffingtonpost.com/2011/05/17/nurses-layoffs-executives-attack_n_862741.html
Brilliant Strategy
Make Them Defend Their Political Christian Stand
I think it is a brilliant strategy to make the religious politicians defend their christian beliefs by calling them out and making them defend their stand on social issues. I know it's nothing new, but now more than ever they are using their faith to push through their political agendas. Reporters need to ask them to explain how they justify these harsh measures as christian values, such as denying women and men health care at planned parenthood, slashing funding for medicaid/medicare, removing children from medicare, eliminating funding for mental health. 81 Catholic Academics sent a letter to Boehner criticizing him for not adhering to his Catholic faith, it was an amazing article and more of this needs to be done.
http://www.huffingtonpost.com/2011/05/11/john-boehner-commencement_n_860791.html
This week we saw a group of twenty organizations call out Walker for an immoral budget and presented an alternative that spreads the burden to all not just the weak and defenseless. Walker and the like need to tell the truth as to why they are doing this, if they don't, they are lying, which all know is a sin.
http://host.madison.com/ct/news/local/grassroots/article_4986c7c6-81c0-11e0-a95a-001cc4c002e0.html
I think it is a brilliant strategy to make the religious politicians defend their christian beliefs by calling them out and making them defend their stand on social issues. I know it's nothing new, but now more than ever they are using their faith to push through their political agendas. Reporters need to ask them to explain how they justify these harsh measures as christian values, such as denying women and men health care at planned parenthood, slashing funding for medicaid/medicare, removing children from medicare, eliminating funding for mental health. 81 Catholic Academics sent a letter to Boehner criticizing him for not adhering to his Catholic faith, it was an amazing article and more of this needs to be done.
http://www.huffingtonpost.com/2011/05/11/john-boehner-commencement_n_860791.html
This week we saw a group of twenty organizations call out Walker for an immoral budget and presented an alternative that spreads the burden to all not just the weak and defenseless. Walker and the like need to tell the truth as to why they are doing this, if they don't, they are lying, which all know is a sin.
http://host.madison.com/ct/news/local/grassroots/article_4986c7c6-81c0-11e0-a95a-001cc4c002e0.html
Friday, May 20, 2011
Walker Administration Warned By The Feds
Feds threaten state with loss of FoodShare funds over privatization
http://www.jsonline.com/news/statepolitics/122347464.htmlThursday, May 19, 2011
Time For Talking Almost Over
The Joint Finance Committee is expected to take up debate on Medicaid next Tuesday. The Wisconsin Legislature budget committee plans to complete it's work by June 4th. Let's hope all of the hard work done by so many wonderful people, stops Walkers corrosive budget and has an impact that will make our State a positive example of what happens when people come together for the greater good of all, not for a select few.
http://www.greenbaypressgazette.com/article/20110519/GPG0101/110519103/1207&located=rss
http://www.greenbaypressgazette.com/article/20110519/GPG0101/110519103/1207&located=rss
Results From: A Call To Action
Wisconsin Council of Children and Families Responds To Budget
http://host.madison.com/ct/news/local/grassroots/article_4986c7c6-81c0-11e0-a95a-001cc4c002e0.html
Great News For Senior Care!
http://www.htrnews.com/article/20110519/MAN0101/305200008/1358&located=rss
http://host.madison.com/ct/news/local/grassroots/article_4986c7c6-81c0-11e0-a95a-001cc4c002e0.html
Great News For Senior Care!
http://www.htrnews.com/article/20110519/MAN0101/305200008/1358&located=rss
Latest Edition of Healthwatch Newsletter
This One Is Packed Full Of Information
Remember to Renew Your HealthWatch Wisconsin Membership for 2011-2012!!
See details below
Joint Finance Committee Votes Down Insurance Policy Readability Improvements
The Joint Finance Committee heard a motion on May 12 to restore the readability of insurance policies to the improved level established in October 2010 by then Commissioner of Insurance Sean Dilweg. HealthWatch Wisconsin has been following this issue extensively, as consumer protections were rolled back by new Commissioner Ted Nickel on February 9 when he issued an "Emergency Rule" to not only make insurance policies harder to read, but also make them harder to receive--blocking a provision for individuals to get policies electronically. The motion to reinstate the rule failed on a 4-12 vote, with all of the Republicans on the committee voting against it. Read the last edition of the HealthWatch Reporter for additional details on the background on improved readability and access to insurance policies. Read a press release issued by Rep. Tamara Grigsby (D-Milwaukee) on this issue.
OCI Hearing on Readability
OCI provides copies of written testimony: 54 oppose emergency rule; 1 in favor!
The Joint Finance motion was inspired by a public hearing, advertised only in the Wisconsin Administrative Register, to hear input on the "Emergency Rule." ABC for Health's Executive Director Bobby Peterson presented testimony at this May 3 hearing, speaking on the importance of consumer protections, the necessary access to information that is lacking, and the feasibility of electronically accessing insurance policies. Erin Aagesen and Jeff Burkhart, representing Wisconsin Literacy and the Literacy Network, respectively, testified to restoring readability to the pre-determined Flesch Reading Score. Physicians like Dr. Paul Smith and members of the community also voiced strong opinions on the importance of readability. No one testified in favor of the emergency rule. What's more, of 55 written testimonies received by OCI, 54 opposed the emergency rule, and only one was in favor of it. Of the written testimonies, only Health Tradition Health Plan supported rolling back the readability requirements, in a letter signed by Steven Kunes, Executive Director; Alan Krumholz MD, Medical Director; Michael Eckstein, Director of Sales and Marketing; and Jennifer Oliver, Compliance Officer/Quality Manager.
Read Guy Boulton's May 7 article in the Milwaukee Journal Sentinel: Mandate for easy-to-read health insurance policies dumped.
Read David Wahlberg's April 22 article in the Wisconsin State Journal: Insurance policy readability may not get better.
Joint Finance Committee To Debate DHS Budget on May 18
The Joint Finance Committee will reconvene on Wednesday, May 18 for a full day with agenda items including those listed below concerning the Department of Health Services. Click below to read the budget papers in advance of the meeting:
* Supplemental Security Income -- Reestimate and Program Transfer
* Delete State Family Planning Funding
* Fees for Patient Health Care Records
* "Family Planning Only" MA Optional Eligibility Group
The New Income Maintenance Manual & Request a Fair Hearing
On May 13, Release 11-01 of the Income Maintenance Manual was made, changing some "first steps" in the fair hearing process.
At first glance, the new IMM release appeared to make the appeals process easier for individuals who disagree with a decision from a state-administered program. Upon closer inspection, however, the process for filing an appeal is actually more strict.
For individuals wishing to request an appeal of a decision for BadgerCare Plus, Medicaid, or Refugee Assistance Program (RAP), or if the individuals requesting an appeal are Child Care participants and providers or SeniorCare participants, they must make their requests for Fair Hearing on the specific Request for Fair Hearing Forms and the member must sign her name on that form.
The old rule used to say:
OLD: When a request is made orally, [the agency will] put it in writing immediately. If it's made in person, have the client sign it. Forward all hearing requests to the Division of Hearings and Appeals (DHA).
The new rule eliminates the “action step” of the agency reducing the oral request to paper on behalf of the member.
NEW: When a request is made orally, provide the customer the option to put the request in writing immediately. If it's made in person, have the member sign the Request for Fair Hearing form.
There is some leniency in the rule change, however, for individuals receiving FoodShare benefits. The new rule indicates that a FoodShare member may request an appeal of a decision on FoodShare orally, and the agency will transcribe the request into writing immediately. The request will be entered on a “Request for Fair Hearing Form” and faxed to the Division of Hearings and Appeals. The agency must also accept a hearing request on an agency denial of restoration of FoodShare benefits.
Advocacy Tip: When working with a family who wishes to appeal a decision on their benefits, whether it be FoodShare, BadgerCare or other program benefits, insist that the appeal request be made in writing on the required form with a signature. The “Request a Fair Hearing Form” is available online. Keep this link handy and help individuals find, complete, and sign this form to begin their appeal process.
Changes to Appeal Options for Fully-Insured Coverage Plans
If you receive a denial from your fully-insured (state-governed) health insurance company or from the HIRSP Authority (Health Insurance Risk Sharing Plan), you typically must exhaust all internal grievances before taking any other steps. These internal grievances are informal dispute resolution processes where the insurance company has the “final say” in your claim. Typically there are two. You do have the option of seeking an opinion from an unbiased or independent source. This process, called an “independent review,” allows you to present your medical and insurance documentation to an outside agency called an Independent Review Organization (IRO). The IRO then determines if the insurance company who denied your claim is indeed correct. In previous years, however, the determination of the IRO was binding to both the client and the insurance company. In other words, if the IRO determined that your denial was unreasonable, the insurance company was obligated to cover the claim. If the determination by the IRO upheld the decision of the insurance company, however, you would have no other recourse; the independent review was your last option of appeal.
Beginning in 2011, an individual who exhausts her fully-insured, or state governed, insurance grievances (or HIRSP grievance procedures) still can make an appeal to an IRO. The change in the law, however, impacts what happens next. If the individual is appealing the denial of 1.) a pre-existing condition or 2.) rescission, the final determination by the IRO is binding only to the insurer and NOT the insured individual. This means that if the determination favors the individual, the insurance company is required to cover the treatment in question. If the IRO denies the appeal, the individual is not bound by that decision, but instead has a final option of appealing to state court.
HealthWatch News
New HealthWatch Membership Year is Coming!
A new membership year begins July 1st!
A new membership drive for 2011-2012 is right around the corner! Watch your inbox and mailbox over the next couple of weeks for information about renewing your membership or joining us for the first time! HealthWatch Wisconsin memberships connect you to great materials, information and events. Join as an individual or as an organization committed to unifying the public health workforce, with emphasis on teaching, training, and information sharing. The membership year runs July 1, 2011-June 30, 2012.
Other Benefits of Joining HealthWatch Wisconsin:
The Landscape of Health Care and Coverage is Changing in Wisconsin! HealthWatch can help! Members will receive publications and materials valued at over $200, FREE with membership. Publications that help you understand, explain and work with public and private insurance programs and navigation strategies are included in your membership, such as: “My Health Reform Guidebook,” the “AdvoKit,” “2011 Resources Guide," "My Medical Debt Survival Guide," "Non-qualified Immigrant Coverage Chart," BadgerCare Plus fact sheets and charts, and more!
Want to watch video trainings at your desk or in the comfort of your own home? HealthWatch Members throughout the 2011-2012 membership year will be eligible to log in to the HealthWatch Training Portal, accessible wherever there is an internet connection.
Members also receive significant discounts to training events and conferences!
Plus, stay tuned for information about Packers Ticket Prize Drawings!
Questions? Call HealthWatch Wisconsin staff for more information: (608) 261-6939 ext. 204.
All Aboard! This Summer, Join Up with the BadgerCare+ Express!
HealthWatch continues to plan the “BadgerCare+ Express,” a coordinated, statewide tour of low-enrollment or uninsured areas where HealthWatch Wisconsin staff, members and leaders will educate consumers and service providers about the enrollment, legal and administrative hurdles that families encounter with BadgerCare+ health coverage programs. HealthWatch hopes to make six BadgerCare+ Express stops across Wisconsin, meeting with families and professionals, providing consumer assistance, and most importantly, conducting education on BadgerCare+ programs, complete with printed “3 Steps to Family Health Coverage” kits.
In select locations, ABC for Health's Health Benefits Counselors will convene workshops for individuals, families, and health care professionals to work through the “3 Steps of Family Health Coverage,” to help promote an understanding of the legal requirements of how to get, use, and keep health coverage. Included in these stops, where appropriate, are counseling sessions, going through eligibility requirements, completing applications, troubleshooting denials, facilitating renewals, and conducting education on other health care coverage programs.
Join us in the final stages of planning or sponsorship: if you know of any local end-of-summer events where the BadgerCare+ Express should stop or would like to help out with organizing a stop, please let us know! The Madison stop of the BadgerCare+ Express will be co-sponsored by the Dane County HealthWatch Coalition. The Milwaukee event will occur during Child Health Week, with co-sponsorship by the Milwaukee HealthWatch Coalition. We will announce the remaining stops soon! HealthWatch is eager to begin this very popular and successful model of enrollment and education for complicated BadgerCare+ and Medicaid coverage programs.
Complete HealthWatch Public Hearing Footage Now Online!
HealthWatch Wisconsin has posted the complete video footage of public testimony on the impact of proposed BadgerCare+ and Medicaid cuts that will affect 1.2 million Wisconsinites covered by these programs. In March, HealthWatch Wisconsin sponsored two days of public hearings during the HealthWatch Wisconsin Annual Conference, drawing hundreds of people to listen, learn, and for some, to share their stories and the stories of loved ones. HealthWatch Wisconsin staff was on hand to record participants' testimony.
View the public testimony footage online.
Grapevine
Publications Free through DHS
Did you know that there is a massive library of publications available for FREE from the Department of Health Services? Check out their order form online! Best of all, you can do everything online - just search the publication library for the publication that you want to order and email the corresponding Forms Manager.
Coalition Roundup
Click here for a list of upcoming coalition meetings.
The Chippewa County HealthWatch Coalition met on May 10 at the Chippewa County Courthouse. Mike Rust of ABC for Rural Health came and spoke to the group about all of the ins and outs of HealthCheck treatment options for Medicaid-enrolled children. The next Chippewa County HealthWatch Coalition meeting is on September 13, 2011. For more information about the Chippewa County HealthWatch Coalition, please contact Rose Marsh.
Dane County HealthWatch Dane County HealthWatch met on May 2 at the Hawthorne Branch of the Madison Public Library. Patricia Frazak and Dan Stattelman-Scanlan of Public Health Madison & Dane County presented their new Fetal and Infant Mortality Review (FIMR) process. Jon Peacock of the Wisconsin Council on Children and Families also attended and spoke on the issue of centralization and potential privatization of income maintenance services in Wisconsin. Finally, Dane County HealthWatch members discussed the new provider contracts for non-emergency medical transportation through LogistiCare at length. The next Dane County HealthWatch meeting will be June 6, back at the usual location at the Waisman Community Outreach Center on East Olin Ave, and the speaker, confirmed for now, will be Amy Mendel-Clemens, the Economic Support Division Administrator for Dane County. For more information about the Dane County HealthWatch Coalition, please contact Adam VanSpankeren.
The Eau Claire County HealthWatch Coalition had their most recent meeting on May 5 at the Luther Hospital Cafeteria. Paula Gibson, Community Relations Director for Harbor House Memory Care, came to speak to the coalition about Harbor’s services and new websites. Pat Perkins of the Eau Claire City-County Health Department gave an update from the annual statewide HealthWatch Wisconsin Conference. The Eau Claire County Coalition doesn't meet over the summer but will be back in action in September! For more information, please contact Lou Kelsey or Pat Perkins.
The Milwaukee HealthWatch Coalition met May 11 to welcome Ramona Gramling who gave overview of CORE/El Centro. CORE/El Centro is a non-profit grassroots volunteer-driven organization that offers individuals of all income levels access to natural healing therapies, including massage, acupuncture, yoga, and more. In addition, attendees had a discussion about administering a competency of self-assessment as part of an overarching strategic plan for the coalition. For more information about the Milwaukee HealthWatch Coalition, please contact Nora Foshager.
The Pierce County HealthWatch Coalition had its kickoff meeting on Thursday, May 12! Mike Rust of ABC for Rural Health came to speak to the group about what is changing - or potentially changing - with Medicaid and BadgerCare in Wisconsin. He also included an explanation of EPSDT for other services, including dental access. The meeting was well attended, and the steering committee collected feedback from the attendees to help shape future meetings. For more information about the Pierce County HealthWatch Coalition, please contact Lisa Raethke.
The Tri-County HealthWatch Coalition held its strategic planning session back in March and developed a draft work plan they presented to the group in April. The group determined that the plan was on the aggressive side, so the steering committee has been working on streamlining it to present a plan with reasonable timelines at their May meeting. Tri-County HealthWatch has also been working collecting the testimonies of people who will be affected by the proposed budget cuts, to send those testimonies to the Joint Finance Committee by the end of May. The group is also working to identify low-income families and get them signed up for BadgerCare+. The next Tri County HealthWatch Coalition meeting is May 24 at the Goodwill Community Center in Menasha. For more information about the Tri-County HealthWatch Coalition, contact Susan Garcia Franz or Connie Raether.
CKSN Corner
Covering Kids with Special Needs
The National Youth Leadership Network announces their new curriculum: Reap What You Sow: Harvesting Support Systems Curriculum Training Packages. Reap What You Sow brings youth and adults together to build support systems. For more information, click here.
May 18. Listening Session hosted by the WI Council on Children’s Long Term Supports, in collaboration with the Department of Health Services. This listening session will get input from families on cost-saving ideas related to the state's Medicaid programs. These ideas will help the Department of Health Services develop plans aimed at improving overall consumer care, streamlining program delivery and stabilizing programs to ensure long-term sustainability. These listening sessions can be accessed directly from your home: you do not have to travel anywhere.
When: May 18, 9:30-10:30am, Secretary Dennis Smith
Where: Telephone Conference Call or Internet Live Meeting
Individuals who are interested in speaking are asked to keep comments to three minutes. Those who would like to share their ideas and do not wish to speak are encouraged to submit their written comments using this online link. (Please note that this online survey will be active through May 20.)
July 25-27. Leadership, Legacy, and Community: A Retreat to Advance Maternal and Child Health (MCH) Scholarship and Practice. Hyatt McDonald's Lodge, Oak Brook, IL. Learn more information here, or register here.
CKSN Resources:
Katie Beckett
CYSHCN centers
Maternal and Child Health Services
Family Voices
Parent to Parent
Ops Memos
Release 11-01 of the Income Maintenance Manual (IMM) was made May 11, 2011. See more on this release above in the Case Tip.
State & National News
Analysis and Comment
Joint Finance Committee Denies Funding to Civil Legal Services
In the April 1 edition of the HealthWatch Update, HealthWatch Wisconsin brought you an analysis titled "The Defunding of Civil Legal Services in Wisconsin," commenting on Governor Walker's budget bill eliminating all indigent civil legal service funding. This funding is currently a Department of Administration budget item. (In comparison, indigent civil legal services were in the 2009-2011 biennial budget at a $1,958,600 appropriation in FY 10 and a base-year appropriation of $2,546,100 in FY 11.)
In the May 12 gathering of the Joint Finance Committee, Senator Robert Jauch (D-Poplar) made a motion to restore $1 million to fund civil legal services in Wisconsin. Senator Lena Taylor (D-Milwaukee) spoke on the motion, saying, "This motion puts $1 million in these services. There are costs from people coming into the courts unrepresented. We learned of this issue two budget cycles ago when the State Bar of Wisconsin presented a study that included a comparison of civil legal services," in addition to a comparison of how other states put $11 or $12 million to build efficiencies into the court system. Taylor continued, "These programs also provide services for working class families-providing an opportunity to get guidance...I would encourage members [of this committee] to support this motion." The motion to restore funding to civil legal services failed on party lines, with the four Democrats on the committee voting for the motion, and the 12 Republicans voting against.
ABC for Health is one of the dedicated non-profit public interest law firms that will feel the impact of this cut. ABC’s attorneys and health benefits counselors help individuals and families determine the best health coverage choices, apply for health coverage programs, negotiate with insurance companies, and challenge insurance claim denials. Cutting civil legal services will harm thousands of Wisconsin families.
Headlines
BadgerCare Plus Basic Audit Letter Report
Legislative Audit Bureau, 9 May 2011
"The Basic Plan was established to provide temporary, unsubsidized health insurance for childless adults on a waiting list for Medical Assistance coverage. Through December 2010, expenditures exceeded revenues by $140,300, and the deficit would have been larger without $1.1 million in federal grant funding that may not be available in the future. Despite recent programmatic changes, concerns remain about the Basic Plan's sustainability." Additional Links of Interest:
* BadgerCare Basic Enrollment Frozen
* State freezes enrollment, raises premiums, for health pool serving childless adults
* Solvency Reports issued December 2010
Wisconsin Poverty Report: Were Antipoverty Policies Effective in 2009?
Institute for Research on Poverty, May 2011
"In this third annual Wisconsin Poverty Report, we use the Wisconsin measure to examine need in 2009 and changes in economic security from 2008 to 2009."
Rule would discourage states' cutting Medicaid payments to providers
Robert Pear, The New York Times, 2 May 2011
"The Obama administration is proposing a rule that would make it much more difficult for states to cut Medicaid payments to doctors and hospitals. Dennis G. Smith, secretary of the Wisconsin Department of Health Services, described the proposal as 'a federal power grab.'”
Vital signs: Health secretary Smith criticizes new fed effort to increase access to health care for the poor Shawn Doherty, The Cap Times, 3 May 2011
"Anybody who had thought the Obama administration might roll over under the increased pressure from Republican states like Wisconsin chafing at the Medicaid bit is wrong. We're headed for a showdown later this year."
Editorial: Repair, not raze, state health plan for the uninsured
The Oshkosh Northwestern, 12 May 2011
"Less than a year after it was created, a state program to extend health insurance to single people is in trouble that requires the repair, not the razing of the program."
Florida Pushing New Fees For Most Medicaid Recipients
http://www.kaiserhealthnews.org/Stories/2011/May/16/florida-medicaid-premiums-fees.aspx
Phil Galewitz, Kaiser Health News, 15 May 2011
"Florida wants to be the first state in the nation to charge most of its Medicaid recipients a monthly premium as well as $100 for using the ER for routine care. But even supporters acknowledge that the new fees, passed recently by the state legislature as part of a sweeping Medicaid measure, face long odds getting federal approval."
Remember to Renew Your HealthWatch Wisconsin Membership for 2011-2012!!
See details below
Joint Finance Committee Votes Down Insurance Policy Readability Improvements
The Joint Finance Committee heard a motion on May 12 to restore the readability of insurance policies to the improved level established in October 2010 by then Commissioner of Insurance Sean Dilweg. HealthWatch Wisconsin has been following this issue extensively, as consumer protections were rolled back by new Commissioner Ted Nickel on February 9 when he issued an "Emergency Rule" to not only make insurance policies harder to read, but also make them harder to receive--blocking a provision for individuals to get policies electronically. The motion to reinstate the rule failed on a 4-12 vote, with all of the Republicans on the committee voting against it. Read the last edition of the HealthWatch Reporter for additional details on the background on improved readability and access to insurance policies. Read a press release issued by Rep. Tamara Grigsby (D-Milwaukee) on this issue.
OCI Hearing on Readability
OCI provides copies of written testimony: 54 oppose emergency rule; 1 in favor!
The Joint Finance motion was inspired by a public hearing, advertised only in the Wisconsin Administrative Register, to hear input on the "Emergency Rule." ABC for Health's Executive Director Bobby Peterson presented testimony at this May 3 hearing, speaking on the importance of consumer protections, the necessary access to information that is lacking, and the feasibility of electronically accessing insurance policies. Erin Aagesen and Jeff Burkhart, representing Wisconsin Literacy and the Literacy Network, respectively, testified to restoring readability to the pre-determined Flesch Reading Score. Physicians like Dr. Paul Smith and members of the community also voiced strong opinions on the importance of readability. No one testified in favor of the emergency rule. What's more, of 55 written testimonies received by OCI, 54 opposed the emergency rule, and only one was in favor of it. Of the written testimonies, only Health Tradition Health Plan supported rolling back the readability requirements, in a letter signed by Steven Kunes, Executive Director; Alan Krumholz MD, Medical Director; Michael Eckstein, Director of Sales and Marketing; and Jennifer Oliver, Compliance Officer/Quality Manager.
Read Guy Boulton's May 7 article in the Milwaukee Journal Sentinel: Mandate for easy-to-read health insurance policies dumped.
Read David Wahlberg's April 22 article in the Wisconsin State Journal: Insurance policy readability may not get better.
Joint Finance Committee To Debate DHS Budget on May 18
The Joint Finance Committee will reconvene on Wednesday, May 18 for a full day with agenda items including those listed below concerning the Department of Health Services. Click below to read the budget papers in advance of the meeting:
* Supplemental Security Income -- Reestimate and Program Transfer
* Delete State Family Planning Funding
* Fees for Patient Health Care Records
* "Family Planning Only" MA Optional Eligibility Group
The New Income Maintenance Manual & Request a Fair Hearing
On May 13, Release 11-01 of the Income Maintenance Manual was made, changing some "first steps" in the fair hearing process.
At first glance, the new IMM release appeared to make the appeals process easier for individuals who disagree with a decision from a state-administered program. Upon closer inspection, however, the process for filing an appeal is actually more strict.
For individuals wishing to request an appeal of a decision for BadgerCare Plus, Medicaid, or Refugee Assistance Program (RAP), or if the individuals requesting an appeal are Child Care participants and providers or SeniorCare participants, they must make their requests for Fair Hearing on the specific Request for Fair Hearing Forms and the member must sign her name on that form.
The old rule used to say:
OLD: When a request is made orally, [the agency will] put it in writing immediately. If it's made in person, have the client sign it. Forward all hearing requests to the Division of Hearings and Appeals (DHA).
The new rule eliminates the “action step” of the agency reducing the oral request to paper on behalf of the member.
NEW: When a request is made orally, provide the customer the option to put the request in writing immediately. If it's made in person, have the member sign the Request for Fair Hearing form.
There is some leniency in the rule change, however, for individuals receiving FoodShare benefits. The new rule indicates that a FoodShare member may request an appeal of a decision on FoodShare orally, and the agency will transcribe the request into writing immediately. The request will be entered on a “Request for Fair Hearing Form” and faxed to the Division of Hearings and Appeals. The agency must also accept a hearing request on an agency denial of restoration of FoodShare benefits.
Advocacy Tip: When working with a family who wishes to appeal a decision on their benefits, whether it be FoodShare, BadgerCare or other program benefits, insist that the appeal request be made in writing on the required form with a signature. The “Request a Fair Hearing Form” is available online. Keep this link handy and help individuals find, complete, and sign this form to begin their appeal process.
Changes to Appeal Options for Fully-Insured Coverage Plans
If you receive a denial from your fully-insured (state-governed) health insurance company or from the HIRSP Authority (Health Insurance Risk Sharing Plan), you typically must exhaust all internal grievances before taking any other steps. These internal grievances are informal dispute resolution processes where the insurance company has the “final say” in your claim. Typically there are two. You do have the option of seeking an opinion from an unbiased or independent source. This process, called an “independent review,” allows you to present your medical and insurance documentation to an outside agency called an Independent Review Organization (IRO). The IRO then determines if the insurance company who denied your claim is indeed correct. In previous years, however, the determination of the IRO was binding to both the client and the insurance company. In other words, if the IRO determined that your denial was unreasonable, the insurance company was obligated to cover the claim. If the determination by the IRO upheld the decision of the insurance company, however, you would have no other recourse; the independent review was your last option of appeal.
Beginning in 2011, an individual who exhausts her fully-insured, or state governed, insurance grievances (or HIRSP grievance procedures) still can make an appeal to an IRO. The change in the law, however, impacts what happens next. If the individual is appealing the denial of 1.) a pre-existing condition or 2.) rescission, the final determination by the IRO is binding only to the insurer and NOT the insured individual. This means that if the determination favors the individual, the insurance company is required to cover the treatment in question. If the IRO denies the appeal, the individual is not bound by that decision, but instead has a final option of appealing to state court.
HealthWatch News
New HealthWatch Membership Year is Coming!
A new membership year begins July 1st!
A new membership drive for 2011-2012 is right around the corner! Watch your inbox and mailbox over the next couple of weeks for information about renewing your membership or joining us for the first time! HealthWatch Wisconsin memberships connect you to great materials, information and events. Join as an individual or as an organization committed to unifying the public health workforce, with emphasis on teaching, training, and information sharing. The membership year runs July 1, 2011-June 30, 2012.
Other Benefits of Joining HealthWatch Wisconsin:
The Landscape of Health Care and Coverage is Changing in Wisconsin! HealthWatch can help! Members will receive publications and materials valued at over $200, FREE with membership. Publications that help you understand, explain and work with public and private insurance programs and navigation strategies are included in your membership, such as: “My Health Reform Guidebook,” the “AdvoKit,” “2011 Resources Guide," "My Medical Debt Survival Guide," "Non-qualified Immigrant Coverage Chart," BadgerCare Plus fact sheets and charts, and more!
Want to watch video trainings at your desk or in the comfort of your own home? HealthWatch Members throughout the 2011-2012 membership year will be eligible to log in to the HealthWatch Training Portal, accessible wherever there is an internet connection.
Members also receive significant discounts to training events and conferences!
Plus, stay tuned for information about Packers Ticket Prize Drawings!
Questions? Call HealthWatch Wisconsin staff for more information: (608) 261-6939 ext. 204.
All Aboard! This Summer, Join Up with the BadgerCare+ Express!
HealthWatch continues to plan the “BadgerCare+ Express,” a coordinated, statewide tour of low-enrollment or uninsured areas where HealthWatch Wisconsin staff, members and leaders will educate consumers and service providers about the enrollment, legal and administrative hurdles that families encounter with BadgerCare+ health coverage programs. HealthWatch hopes to make six BadgerCare+ Express stops across Wisconsin, meeting with families and professionals, providing consumer assistance, and most importantly, conducting education on BadgerCare+ programs, complete with printed “3 Steps to Family Health Coverage” kits.
In select locations, ABC for Health's Health Benefits Counselors will convene workshops for individuals, families, and health care professionals to work through the “3 Steps of Family Health Coverage,” to help promote an understanding of the legal requirements of how to get, use, and keep health coverage. Included in these stops, where appropriate, are counseling sessions, going through eligibility requirements, completing applications, troubleshooting denials, facilitating renewals, and conducting education on other health care coverage programs.
Join us in the final stages of planning or sponsorship: if you know of any local end-of-summer events where the BadgerCare+ Express should stop or would like to help out with organizing a stop, please let us know! The Madison stop of the BadgerCare+ Express will be co-sponsored by the Dane County HealthWatch Coalition. The Milwaukee event will occur during Child Health Week, with co-sponsorship by the Milwaukee HealthWatch Coalition. We will announce the remaining stops soon! HealthWatch is eager to begin this very popular and successful model of enrollment and education for complicated BadgerCare+ and Medicaid coverage programs.
Complete HealthWatch Public Hearing Footage Now Online!
HealthWatch Wisconsin has posted the complete video footage of public testimony on the impact of proposed BadgerCare+ and Medicaid cuts that will affect 1.2 million Wisconsinites covered by these programs. In March, HealthWatch Wisconsin sponsored two days of public hearings during the HealthWatch Wisconsin Annual Conference, drawing hundreds of people to listen, learn, and for some, to share their stories and the stories of loved ones. HealthWatch Wisconsin staff was on hand to record participants' testimony.
View the public testimony footage online.
Grapevine
Publications Free through DHS
Did you know that there is a massive library of publications available for FREE from the Department of Health Services? Check out their order form online! Best of all, you can do everything online - just search the publication library for the publication that you want to order and email the corresponding Forms Manager.
Coalition Roundup
Click here for a list of upcoming coalition meetings.
The Chippewa County HealthWatch Coalition met on May 10 at the Chippewa County Courthouse. Mike Rust of ABC for Rural Health came and spoke to the group about all of the ins and outs of HealthCheck treatment options for Medicaid-enrolled children. The next Chippewa County HealthWatch Coalition meeting is on September 13, 2011. For more information about the Chippewa County HealthWatch Coalition, please contact Rose Marsh.
Dane County HealthWatch Dane County HealthWatch met on May 2 at the Hawthorne Branch of the Madison Public Library. Patricia Frazak and Dan Stattelman-Scanlan of Public Health Madison & Dane County presented their new Fetal and Infant Mortality Review (FIMR) process. Jon Peacock of the Wisconsin Council on Children and Families also attended and spoke on the issue of centralization and potential privatization of income maintenance services in Wisconsin. Finally, Dane County HealthWatch members discussed the new provider contracts for non-emergency medical transportation through LogistiCare at length. The next Dane County HealthWatch meeting will be June 6, back at the usual location at the Waisman Community Outreach Center on East Olin Ave, and the speaker, confirmed for now, will be Amy Mendel-Clemens, the Economic Support Division Administrator for Dane County. For more information about the Dane County HealthWatch Coalition, please contact Adam VanSpankeren.
The Eau Claire County HealthWatch Coalition had their most recent meeting on May 5 at the Luther Hospital Cafeteria. Paula Gibson, Community Relations Director for Harbor House Memory Care, came to speak to the coalition about Harbor’s services and new websites. Pat Perkins of the Eau Claire City-County Health Department gave an update from the annual statewide HealthWatch Wisconsin Conference. The Eau Claire County Coalition doesn't meet over the summer but will be back in action in September! For more information, please contact Lou Kelsey or Pat Perkins.
The Milwaukee HealthWatch Coalition met May 11 to welcome Ramona Gramling who gave overview of CORE/El Centro. CORE/El Centro is a non-profit grassroots volunteer-driven organization that offers individuals of all income levels access to natural healing therapies, including massage, acupuncture, yoga, and more. In addition, attendees had a discussion about administering a competency of self-assessment as part of an overarching strategic plan for the coalition. For more information about the Milwaukee HealthWatch Coalition, please contact Nora Foshager.
The Pierce County HealthWatch Coalition had its kickoff meeting on Thursday, May 12! Mike Rust of ABC for Rural Health came to speak to the group about what is changing - or potentially changing - with Medicaid and BadgerCare in Wisconsin. He also included an explanation of EPSDT for other services, including dental access. The meeting was well attended, and the steering committee collected feedback from the attendees to help shape future meetings. For more information about the Pierce County HealthWatch Coalition, please contact Lisa Raethke.
The Tri-County HealthWatch Coalition held its strategic planning session back in March and developed a draft work plan they presented to the group in April. The group determined that the plan was on the aggressive side, so the steering committee has been working on streamlining it to present a plan with reasonable timelines at their May meeting. Tri-County HealthWatch has also been working collecting the testimonies of people who will be affected by the proposed budget cuts, to send those testimonies to the Joint Finance Committee by the end of May. The group is also working to identify low-income families and get them signed up for BadgerCare+. The next Tri County HealthWatch Coalition meeting is May 24 at the Goodwill Community Center in Menasha. For more information about the Tri-County HealthWatch Coalition, contact Susan Garcia Franz or Connie Raether.
CKSN Corner
Covering Kids with Special Needs
The National Youth Leadership Network announces their new curriculum: Reap What You Sow: Harvesting Support Systems Curriculum Training Packages. Reap What You Sow brings youth and adults together to build support systems. For more information, click here.
May 18. Listening Session hosted by the WI Council on Children’s Long Term Supports, in collaboration with the Department of Health Services. This listening session will get input from families on cost-saving ideas related to the state's Medicaid programs. These ideas will help the Department of Health Services develop plans aimed at improving overall consumer care, streamlining program delivery and stabilizing programs to ensure long-term sustainability. These listening sessions can be accessed directly from your home: you do not have to travel anywhere.
When: May 18, 9:30-10:30am, Secretary Dennis Smith
Where: Telephone Conference Call or Internet Live Meeting
Individuals who are interested in speaking are asked to keep comments to three minutes. Those who would like to share their ideas and do not wish to speak are encouraged to submit their written comments using this online link. (Please note that this online survey will be active through May 20.)
July 25-27. Leadership, Legacy, and Community: A Retreat to Advance Maternal and Child Health (MCH) Scholarship and Practice. Hyatt McDonald's Lodge, Oak Brook, IL. Learn more information here, or register here.
CKSN Resources:
Katie Beckett
CYSHCN centers
Maternal and Child Health Services
Family Voices
Parent to Parent
Ops Memos
Release 11-01 of the Income Maintenance Manual (IMM) was made May 11, 2011. See more on this release above in the Case Tip.
State & National News
Analysis and Comment
Joint Finance Committee Denies Funding to Civil Legal Services
In the April 1 edition of the HealthWatch Update, HealthWatch Wisconsin brought you an analysis titled "The Defunding of Civil Legal Services in Wisconsin," commenting on Governor Walker's budget bill eliminating all indigent civil legal service funding. This funding is currently a Department of Administration budget item. (In comparison, indigent civil legal services were in the 2009-2011 biennial budget at a $1,958,600 appropriation in FY 10 and a base-year appropriation of $2,546,100 in FY 11.)
In the May 12 gathering of the Joint Finance Committee, Senator Robert Jauch (D-Poplar) made a motion to restore $1 million to fund civil legal services in Wisconsin. Senator Lena Taylor (D-Milwaukee) spoke on the motion, saying, "This motion puts $1 million in these services. There are costs from people coming into the courts unrepresented. We learned of this issue two budget cycles ago when the State Bar of Wisconsin presented a study that included a comparison of civil legal services," in addition to a comparison of how other states put $11 or $12 million to build efficiencies into the court system. Taylor continued, "These programs also provide services for working class families-providing an opportunity to get guidance...I would encourage members [of this committee] to support this motion." The motion to restore funding to civil legal services failed on party lines, with the four Democrats on the committee voting for the motion, and the 12 Republicans voting against.
ABC for Health is one of the dedicated non-profit public interest law firms that will feel the impact of this cut. ABC’s attorneys and health benefits counselors help individuals and families determine the best health coverage choices, apply for health coverage programs, negotiate with insurance companies, and challenge insurance claim denials. Cutting civil legal services will harm thousands of Wisconsin families.
Headlines
BadgerCare Plus Basic Audit Letter Report
Legislative Audit Bureau, 9 May 2011
"The Basic Plan was established to provide temporary, unsubsidized health insurance for childless adults on a waiting list for Medical Assistance coverage. Through December 2010, expenditures exceeded revenues by $140,300, and the deficit would have been larger without $1.1 million in federal grant funding that may not be available in the future. Despite recent programmatic changes, concerns remain about the Basic Plan's sustainability." Additional Links of Interest:
* BadgerCare Basic Enrollment Frozen
* State freezes enrollment, raises premiums, for health pool serving childless adults
* Solvency Reports issued December 2010
Wisconsin Poverty Report: Were Antipoverty Policies Effective in 2009?
Institute for Research on Poverty, May 2011
"In this third annual Wisconsin Poverty Report, we use the Wisconsin measure to examine need in 2009 and changes in economic security from 2008 to 2009."
Rule would discourage states' cutting Medicaid payments to providers
Robert Pear, The New York Times, 2 May 2011
"The Obama administration is proposing a rule that would make it much more difficult for states to cut Medicaid payments to doctors and hospitals. Dennis G. Smith, secretary of the Wisconsin Department of Health Services, described the proposal as 'a federal power grab.'”
Vital signs: Health secretary Smith criticizes new fed effort to increase access to health care for the poor Shawn Doherty, The Cap Times, 3 May 2011
"Anybody who had thought the Obama administration might roll over under the increased pressure from Republican states like Wisconsin chafing at the Medicaid bit is wrong. We're headed for a showdown later this year."
Editorial: Repair, not raze, state health plan for the uninsured
The Oshkosh Northwestern, 12 May 2011
"Less than a year after it was created, a state program to extend health insurance to single people is in trouble that requires the repair, not the razing of the program."
Florida Pushing New Fees For Most Medicaid Recipients
http://www.kaiserhealthnews.org/Stories/2011/May/16/florida-medicaid-premiums-fees.aspx
Phil Galewitz, Kaiser Health News, 15 May 2011
"Florida wants to be the first state in the nation to charge most of its Medicaid recipients a monthly premium as well as $100 for using the ER for routine care. But even supporters acknowledge that the new fees, passed recently by the state legislature as part of a sweeping Medicaid measure, face long odds getting federal approval."
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