Monday, July 4, 2011

Healthwatch Newsletter July 1st

A New Direction for Wisconsin

Friday, July 1 is the first day of the new fiscal year for the state of Wisconsin--and the first day under Governor Walker's new biennial budget. In this edition of the Update newsletter, we recap some of the changes most likely to impact the health care and coverage of the people of Wisconsin.
Wisconsin's new budget, together with select sections of Act 10 (a.k.a. "Budget Repair" or "Collective Bargaining Bill") resuscitated by the Wisconsin Supreme Court, Wisconsin's Department of Health Services (DHS) has been given an unprecedented delegation of legislative authority to write the rules of the Wisconsin Medicaid Program. The budget gives legislative authority to unelected leaders of DHS to make changes to BadgerCare and Medicaid programs with very limited oversight and no public input. The budget simply eliminates the requirement that the department hold any meetings, and there is no requirement for publication of whatever changes DHS makes to the programs, including any of the "unspecified changes" DHS can make in benefits and eligibility. Read more inside today's Update.

LogistiCare Takes Over Non-Emergency Medical Transportation Services in Wisconsin

July 1 is the implementation date of the new contract between the Wisconsin Department of Health Services (DHS) and LogistiCare, the private company now charged with providing non-emergency medical transportation for the entire state of Wisconsin. In a press release dated June 30, the Deputy Secretary of DHS is quoted as saying, "Whether you are in a rural or urban area, you will be able to count on the same level of service...we are now able to offer Medicaid enrollees better ride coordination and service quality." LogistiCare said it currently employs 87 people in its Wisconsin call center, including Spanish and Hmong speakers. HealthWatch Wisconsin has been following this transition from county managed to privatized services. To read how things are going on the first day of the contract, see our Grapevine Issue below.

Rate Review in Wisconsin: Public Meeting Held

The Affordable Care Act, (health reform) requires states and the federal government to review private health insurance premium increases that appear excessive. In a final regulation, the U.S. Department of Health and Human Services (HHS) has determined that an insurance plan rate increase of 10% or more is considered "unreasonable."
HealthWatch Wisconsin provided extensive background information on the concept and progress of rate review in Wisconsin in its popular investigative newsletter, the HealthWatch Reporter.
On June 29, Wisconsin’s OCI held its first public meeting to give an update on the rate review grant progress in Wisconsin. Unfortunately, the meeting was mercifully short and included many insurance industry representatives (e.g., Anthem BlueCross/BlueShield, Medica, Network Health Plan, United HealthCare, Security Health Plan, Humana, and Trilogy), but few consumer advocates. OCI staff read the first three pages of the meeting’s handout before Guenther Ruch, the OCI staff person heading the meeting, opened it up for open questioning. Some of the initial points made by OCI were:
  • OCI hired an actuarial consultant.
  • Wisconsin regulatory authority rests with a competitive market.
  • ACA grant money is being used to enhance and preserve our competitive marketplace.
  • OCI wants to be “proactively reactive to what is going on.”
  • Current rate filings vary widely and are inconsistent.
  • Website information is not consumer friendly.
To efficiently review requests for rate increases, OCI said it will contract with a variety of outside actuarial entities to determine the reasonableness of requests that fall into a certain “review path.” Review paths range from “a review for completeness of required items and consistency with previous filings to a referral to an actuarial consultant for review of trend assumptions, assessment of impact and appropriateness of rate increase, validation of calculations and formulas, etc.”
HealthWatch Wisconsin will continue to follow this topic and the other key benchmarks required to maintain the federal money for rate review in Wisconsin.

Health Reform Implementation: July 1, 2011

July 1, 2011 is another trigger date for parts of the Affordable Care Act (health reform) to go into effect. States can anticipate very few changes, the most noticeable being that federal Medicaid will not reimburse hospitals or health care facilities for "health care-acquired conditions" such as hospital-acquired infections. The rule also authorizes states to identify other provider-preventable conditions for which Medicaid payment will be prohibited.

New Regulations on Internal Claims & Appeals and External Review

The Affordable Care Act incorporates new language to require insurance issuers to incorporate the internal claims and appeal processes rules promulgated by the Department of Labor. Similarly, with respect to internal claims and appeals processes for individual health insurance coverage, issuers must initially incorporate the internal claims and appeals processes set forth in applicable state law and update such processes in accordance with standards established by the Secretary of the US Department of Health and Human Services (HHS).
These rules are currently being circulated for public comment. The intent is to help plans and issuers in coming into full compliance with the law through an orderly and expeditious implementation process. Comments are due on or before July 25, 2011 to the address listed in the rule.
What to Watch: A bill is being drafted and circulated to give Wisconsin's Commissioner of Insurance (OCI) rule-making authority (equivalent to the unusual delegation of legislative authority the state budget granted DHS Secretary Dennis Smith). In the current draft of this legislation, OCI is able to roll back the improvements made to Wisconsin's internal claims and appeals processes and external review. HealthWatch Wisconsin will be following this issue and featuring any developments in a future edition of the Update

Enrollment Services Center Applications

A tip for applications you submit to the Enrollment Services Center:
Childless Adults may be familiar with the Enrollment Services Center (ESC), the application site for Medicaid, BadgerCare Plus Core Plan, BadgerCare Plus Basic Plan, and FoodShare. While the Core Plan and Basic Plan programs aren’t accepting new applicants (the Core Plan is taking applications for the Waiting List only) individuals may still apply for Medicaid and FoodShare through the ESC. If a childless adult already has coverage through Core Plan or the Basic Plan, or already has FoodShare benefits, she is not prohibited from applying for Medicaid (perhaps through Elderly, Blind and Disabled Medicaid—EBD) if she is interested in a disability benefit program. This individual or her advocate will need to pay careful attention to this new application, as the applicant already has an open benefits case at the ESC. To prevent mix-ups, lost applications, or delays, consider calling the ESC prior to the submission of a new benefits application to request the “case number” from the applications open FoodShare or Core Plan case. Include this case number on the new benefits application so the cases link together at the ESC.
For example, Susan applied for Core Plan coverage back in September 2009. Since obtaining coverage, Susan has been in and out of the hospital several times and her medical conditions have worsened dramatically. She is now hospitalized and will require a nursing home. Susan’s advocate helps her complete the applications for Elderly, Blind and Disabled Medicaid to help her obtain Medicaid coverage. Before sending in her application forms to the ESC, either Susan or her advocate should call the ESC at 1-800-291-2002 to request the case number assigned to Susan on her Core Plan case file. They will write this number on her Elderly, Blind and Disabled Medicaid application. The advocate should then follow up with the ESC to make sure the case worker has all the appropriate application and verification information.

LogistiCare Off to a Shaky Start in Madison?

LogistiCare’s contracts for non-emergency medical transportation for Wisconsin began today, and already HealthWatch has been hearing some interesting things. In Madison, some people have arrived at their appointments late, including urgent care appointments, and others have been concerned that the vehicles of the private drivers that LogistiCare works with are not marked in any way.
More and more, we’re hearing that people don’t know who they talked to and aren’t sure who to call. Remember, to schedule transportation to a non-emergency medical appointment, you should call LogistiCare at 866-907-1493. If you have any problems, try to get the name of the person you talked to and keep a written record of the exchange. HealthWatch will continue to track this issue in future editions of the Update. Stay tuned for more information!
Have trouble with LogistiCare or hear anything about this?  Contact HealthWatch Wisconsin and let us know! Together we can get more attention on this issue!

HealthWatch Public Hearings: The Human Impact of Medicaid/ BadgerCare Cuts in Wisconsin

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.
Member Profile
Sara Finger, Executive Director of the Wisconsin Alliance for Women's Health
By Katie Foran-McHale

A long-time advocate for women’s health issues, Sara Finger spearheaded an effort in 2004 to create an organization that would unite and amplify the voices of women’s health advocates in Wisconsin, ultimately resulting in the creation of the Wisconsin Alliance for Women’s Health.
At WAWH, Sara scans the news for issues that have an effect on women’s health, monitoring policies that affect women on both the state and national level. After identifying issues, she and her team work to create messages around those policies, leading to fact sheets, calls to action, press releases, impact statements and more.
“We work to inform, engage, empower and mobilize our supporter base,” she said.
Sara and the WAWH work to create a supporter base built up of a wide diversity of organizations, including non-traditional partners like health care professionals, women of color, and the business, rural and faith communities. “It’s not a one size fits all message, it’s not a one size fits all movement,” she said.
With issues that can pertain to these partners, Sara and the WAWH provide individual focuses that examines the impact of women’s health issues from specific angles. For the business community, they examine women’s health issues and their economic impact. For women of color, they examine issues from a cultural competency standpoint, ensuring that women are provided with adequate choices. With the faith community, they approach issues from a social justice standpoint. With the rural community and health care professionals, they focus on access to care.
Sara develops relationships with these partners, working together to help shape policy that supports women’s health. Recently, the WAWH worked with members of the Catholic community to support compassionate care for rape victims, with the Catholic community citing that providing emergency contraception is the compassionate thing to do.  
Sara and the WAWH work with at least 50 organizations on women’s health issues, one of them being HealthWatch Wisconsin. Sara has been a member since 2005 (and is a brand-new Council member), involved with the Save BadgerCare Coalition and projects related to health care reform, consumer assistance and various Medicaid programs.
She said the resources HealthWatch Wisconsin provides are invaluable to her and her organization, providing health care advocacy, legal advocacy and navigation that fit well with the WAWH’s mission. Sara is a member of the HealthWatch Wisconsin leadership team, the HealthWatch Council.
Currently, Sara is concerned with the way she feels women’s health issues are being marginalized in Wisconsin’s and the nation’s current political climate.
“We find people shying away from women’s health below the waist, and more than ever, we need to look at the full health, well being and economic security of women if we’re truly going to raise the status of Wisconsin women’s health,” she said.
However, she said this need for advocacy provides inspiration. “The hijacking of certain women’s health issues has really motivated us to set the record straight, and develop messages and messengers that can help us reclaim and reframe the debate.”
For more information about the Wisconsin Alliance for Women’s Health, visit

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.
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.
September 21. Making Connections: Care in the Community Conference. Radisson Hotel, Wauwatosa, WI. Topics will include advocacy, mental health, transition and a health benefits update. For more information, visit
September 22. Did you know? Now you know! Aging and Disability Resource Center of Manitowoc County, Manitowoc, WI. 5:30-8:30 p.m. Topic: Parents and partners on a journey; public support systems available to assist you and your child; private insurance and your provider. To register, call 877-568-5205 or email
October 1. Did you know? Now you know! Aging and Disability Resource Center of Manitowoc County, Manitowoc, WI. 9 a.m.-noon. Topic: More about Medicaid; advocating for systems change. To register, call 877-568-5205 or email

State & National News
Analysis and Comment

Day 1 Under the New Budget

The unspecified cuts to Medicaid and BadgerCare programs can be anything from reducing income eligibility, increasing premiums or co-pays, increasing the number of verifications or reviews, changing covered services, eliminating dual eligibility (for private insurance and BadgerCare), offering different benefits for different people, and more. We will not know for sure what the cuts will actually look like--but can take a nod from sections of the budget and Act 10. What we do know is that DHS can change rules with relatively no oversight and without any requirements to tell anyone what they are doing. HealthWatch is following additional items in the budget that impact the care and coverage of our residents. Below are a few more (in addition to those discussed in our last several newsletters):
1. Income Maintenance: The Enrollment Center "Compromise." The original plan to have a central enrollment center akin to the enrollment services center used for the BadgerCare Plus Core Plan was nixed in the final version of the budget. Instead, a re-organization and grouping of county income maintenance workers will be created. The budget calls for the creation of 10 multi-county consortia, outside Milwaukee County, and directs the state to replace Milwaukee County IM workers with state positions.
2. Give DHS Your Overmatch! Buried in the budget, actually included in the requirement that county consortia be formed for income maintenance functions, is the requirement that counties (except Milwaukee) contribute the cost of their current income maintenance overmatch to support the cost of DHS contracts with the income maintenance consortia! HealthWatch Wisconsin will definitely follow this topic and bring you in-depth reporting on this in the near future.
3. Family Planning Only Services Say Goodbye to Men. The budget ended the relatively recent addition of men to the BadgerCare Plus Family Planning Only Services program. A federal waiver allowed the state to provide these services to men in the first place. The budget states that family planning services can be offered to women between the ages of 15 and 44 as long as the family income is below 200% FPL. The budget directs DHS to request federal approval to require parental notification for family planning services to women under 18.
4. Contraceptive Equity. This provision, designed to eliminate the state mandate that health insurance policies provide coverage for contraceptives prescribed by a health care provider and outpatient medical services related to contraceptives, was REMOVED from the state budget as being non-fiscal. It is anticipated that this is not the end for this issue--watch for a standalone bill on this subject.
5. Goodbye Legal Services Money. Discussed in the Update in past months, the anticipated cuts to civil legal services are official. Governor Walker's budget eliminates all indigent civil legal service funding. (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.)  ABC for Health is one of the 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. Many of our clients are overwhelmed with the changes ahead in Medicaid and private insurance. Consumers are confused by the political conversation about which programs are actually in effect, how to enroll or challenge denials, and what appeals and other legal rights are available. Cutting civil legal services, in addition to blocking health reform’s implementation and reducing enrollment and expenditures in BadgerCare and Medicaid programs, will harm thousands of Wisconsin families.


Urge feds to consider health grant applications without Gov. Walker's support
Representative Jon Richards, Representative Sandy Pasch, 1 July

"Please consider Community Transformation Grant applications originating from Wisconsin without support from Governor Walker, whose opposition to these grants appears to be driven more by ideology than facts."
State blocks plans to apply for federal health grants
Guy Boulton, Milwaukee Journal Sentinel, 29 June

"The state is blocking plans by the Milwaukee Health Department and University Health Services in Madison to apply for federal grants that would provide about $27.5 million for health programs designed to promote healthier lifestyles and reduce chronic diseases such as diabetes."
Former HHS Secretary Leavitt says most states aren't on track to meet exchange deadline
Christopher Weaver and Bara Vaida, Kaiser Health News, 27 June
"Many Republican officials have been conflicted about whether to ignore the requirements or to go ahead with planning exchanges to fend off the federal government."

Wisconsin slips in health care quality ranking
Guy Boulton, Milwaukee Journal Sentinel, 19 June

"But it performs below average in 27 measures, such as adequate dialysis and certain infections stemming from medical care. Wisconsin also does a dismal job in providing care to African-Americans that is similar to the care given to whites."

Click here for more health care news!

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