Friday, April 29, 2011

No Respect For The Less Fortunate

There Is So Much To Hate About Walkers Plans For Privatization

Walker plan brings warning from USDA

Privatizing FoodShare work could cost state $20 million

Madison — Gov. Scott Walker's proposal to privatize work determining who is eligible for food assistance in the state would violate federal law and could expose the state to a loss of more than $20 million in federal money, federal officials say.
In an April 14 letter to state Health Services Secretary Dennis Smith and Children and Families Secretary Eloise Anderson, Ollice Holden, a Midwest administrator for the USDA's Food and Nutrition Service, warned that the work of interviewing applicants and deciding who is eligible for the Wisconsin FoodShare program needs to be done by public workers who are essentially civil servants. If not, he said, the state could lose some of the federal funds supporting FoodShare, the successor in Wisconsin to the food stamp program.
In a statement released Thursday, U.S. Agriculture Secretary Tom Vilsack said, "Recent state agency privatization initiatives in Texas and Indiana have been complete failures, marked by technical difficulties, staffing shortages, and inadequate training of private call-center staff and resulting in adverse impacts on the state and its people.
"USDA will continue to work with Wisconsin to improve its program delivery and integrity so that the most vulnerable people in the state receive the nutrition benefits they need," Vilsack said.
Walker's proposal is just the latest strain on the state's partnership with the federal government on FoodShare. Two weeks ago, USDA officials said that state officials didn't inform them about their discovery last fall of the alleged theft of at least $290,000 in federal FoodShare benefits by Milwaukee County workers.
The FoodShare program in Wisconsin has more than 800,000 participants and distributes more than $1 billion a year to help low-income residents buy food. The program is largely funded by the federal government but is currently administered by the state and counties, with counties largely doing the work of interviewing applicants to see if they qualify for FoodShare and state health programs such as BadgerCare Plus.
One exception is Milwaukee County, where as of January 2010 the state finished taking over determining eligibility for county residents.
Walker's proposed 2011-'13 budget would take this work from the remaining counties and centralize it with the state by using a private contractor to do much of the work. The Walker administration estimates that the proposal would save $48 million per year and eliminate 270 positions.
But Holden said the action could also cause the state to lose federal funds used to help pay for the cost of administering FoodShare in Wisconsin. In 2010, the state received $20.5 million in federal money for that purpose plus another $2.3 million in one-time federal stimulus money.
Seth Boffeli, a spokesman for the state Department of Health Services, said that officials there are aware of the federal government's concerns and are working to come up with a new plan for consolidating intake work in programs for the needy.
"Again, it would be presumptuous to say that we would or wouldn't qualify for the federal match as we have yet to finalize a . . . plan. USDA has shared their concerns and we are taking them under consideration as we work on building the final centralization plan," he said.
In his letter, Holden said that the state was allowed to take over work now done by counties. But under federal rules only civil servants could have direct contact with applicants for and participants in FoodShare. Contractors can do some other tasks such as data entry and document scanning, he said.
Top state GOP lawmakers already said this week that they had concerns about the proposal by Walker, a fellow Republican, and were looking at other options.

Counties also concerned

Counties have also voiced concerns about the proposal. John Reinemann, who directs the lobbying efforts for the Wisconsin Counties Association, said the loss of federal funds would be a serious cost to the state.
"It's absolutely one more reason not to do it," Reinemann said of the federal objections.
Reinemann said county workers could do a better job of steering food stamp and health coverage applicants toward other services such as county transportation or child protective services. He said he was concerned that a for-profit company might be more focused on its bottom line than on priorities such as helping needy state residents or rooting out fraud.
Reinemann said counties would like to see a model where they formed groups to work together to serve participants more efficiently and save taxpayers money.
Newly elected Dane County Executive and former Democratic lawmaker Joe Parisi said he was concerned the proposal would lead to less personal contact between applicants and staff and end up pushing applicants to seek benefits through the Internet or by telephone.

Other states regret plan

Federal officials pointed to past problems with privatization deals in other states such as Indiana and Texas. In 2009, Indiana Gov. Mitch Daniels' administration dropped IBM's $1.4 billion contract to handle intake for residents of that state seeking health coverage and food assistance.
The state ended up suing the company for allegedly failing to live up to the contract and provide adequate service to sick and needy residents, said Marcus Barlow, a spokesman for the Indiana Family and Social Services Administration. The dispute drags on in court.
Sherrie Tussler, executive director of the Hunger Task Force in Milwaukee, said she saw advantages in having a centralized, state system staffed by public employees for handling FoodShare intake rather than having individual counties do the work. Having the responsibilities split between the state and counties means that it's harder to hold any one agency accountable for how the program is run, Tussler said.
"In state-run programs, the state has a lower administrative cost and a lower error rate," she said.
But Tussler said she also had worries that a private contractor might not provide adequate service to participants.
Tussler said she already had concerns about the use of contractors and the quality of service in Wisconsin's Enrollment Services Center. That center, begun during the administration of Democratic Gov. Jim Doyle, already consolidates intake at a statewide level but only serves childless adults seeking FoodShare or health care benefits.

Tuesday, April 26, 2011

What Your Taxes Pay For

I Think This Was A Brilliant Idea! 

The White House posted this on their official website:

It's the federal taxpayer receipt, it explains how your tax dollars are being spent. You answer a few questions and it will calculate what your taxes payed for by percentage. The information is easy to read and answers basic tax questions. It's worth a look. Here is the link for the White House website:
It's also worth your time to go over the information on the website. I started to poke around in the health care and disability section. I'll have to back and take a closer look, I'm kinda tired today, I'll need to be more alert in order to comprehend what I am reading.

Same Old Line

How many times have you heard people say ' I don't want my taxes to pay for someones........? We all pay taxes one way or another and some more than others, either way we all end up helping each other, once again, some more than others. I know very little about how taxes work but they do play a vital role in our lives. After a natural disaster government agencies provide security and basic necessities. Taxes pay for roads and bridges, and many things we take for granted as well as many things we seem to despise. As the saying goes.... it's a necessary evil. If you could personally chose what the Government spent your tax money on, what would it be?

Feeling More Confident

As I peruse the internet looking for information about this battle, I am becoming more confident that this is an issue that the general population is willing to fight for. The spirit of compassion is alive and well. People are beginning to take notice because the decisions being presented and being made have life and death consequences. I see a growing number of people with the authority to make such decisions taking a stand for the people that cannot stand up for themselves. The ground support for health care started off as a whisper, it's now a growing roar, it will reach a crescendo in the next election.

This country is always there for other countries when they are in need and yet when it comes to our own, we turn on each other and call our neighbors lazy, slobs or deadbeats. I am unable to understand this line of reasoning, maybe someone could explain it to me.

Thank you for your time today


Articles And Emails

Articles Worth Sharing

Shared Emails From Advocacy Groups 

As many of you know, a few key legislative proposals have placed Medicaid and other entitlement programs under fire.  Earlier this month, the House approved Budget Committee Chairman Paul D. Ryan’s budget proposal, which included a provision to block grant Medicaid.  In addition, Sen. McCaskill (D-MO) and Sen. Corker (R-TN) have proposed a bipartisan bill that aims to cap total federal spending and includes a “sequestration” process that would automatically make cuts if the cap was exceeded.  Meanwhile, in the background looms another threat to Medicaid: across the board spending cuts.  As the nation is about to hit the debt ceiling in early May, Republicans have pounced on the opportunity to leverage the debt ceiling bill for statutory spending caps, a balanced budget amendment and a two-thirds vote requirement for tax increases and debt limit increases.
These measures have been couched as neutral proposals to reduce the deficit, but they destructively cut entitlement and mandatory programs, like Medicaid.  Inadequate federal funding for Medicaid translates into two possibilities: states shouldering the costs so that they can operate their Medicaid programs at the pre-cut level, or states cutting services and/or eligibility to fit within the reduced federal funding limit.   Given today’s economic and political climate, it is more likely than not that states will opt for the second option and cut services.
These cuts would be devastating for the 30 million children and other vulnerable populations who rely on Medicaid.  As advocates, we must make sure that we stand against any proposal to block grant, cap or cut Medicaid, and demand that the program remain fully funded.
Below is an article highlighting how the debt ceiling bill is being used as vehicle to cut funding for Medicaid.  A report from the Center for Budget and Policy Priorities that explains how federal spending caps would be detrimental to entitlement programs is attached.

By Ezra Klein                                                                                                                                      
The GOP is starting to get specific about what they’re going to demand in return for increasing the debt limit. House Majority Leader Eric Cantor says “major spending cuts or budget process reforms.” Karl Rove says “robust spending and deficit caps requiring rescissions and cuts if spending or deficits breach historic norms.” Note the focus on procedural change. Most in the GOP have concluded -- rightly, I think -- that the debt limit debate won’t offer the time or the space for a comprehensive deficit deal. So the question is how the budget process could be remade going forward such that the next comprehensive deficit deal -- or everything that happens in the absence of a comprehensive deficit deal -- is more to their liking.
Many on the Hill and in the White House expect that the debate will ultimately come down to two alternatives: the McCaskill-Corker spending cap, which would hold federal spending at 20.6 percent of GDP -- more than three percentage points lower than it is now, and much lower than it’s projected to be later -- and the deficit-reducing trigger that the president included in his budget.
I’ve spent some time looking at the McCaskill-Corker cap and haven’t come away impressed: it focuses on spending rather than debt, sets unrealistic targets given the aging of the population and rising health-care costs and poses a substantial risk of creating a strong incentive for politicians to shift their spending into the tax code, where it wouldn’t count against the cap. But the GOP has repeatedly shown itself more interested in attacking spending than in attacked debt (see “Bush tax cuts, the”) and would like budget strictures that lead to policy being driven through tax credits rather than through direct spending. In a way, the McCaskill-Corker cap forces an approach much like Paul Ryan’s, where the government saves money not by making reforms so much as by shedding obligations.
Obama’s deficit trigger works quite differently: it’s focused on how much debt we have rather than how much spending we’re doing, and when triggered, it makes automatic cuts in both a variety of categories of spending (though with some major exemptions, like Medicare and Social Security) and a variety of tax expenditures. In that way, one of its solutions to debt is to raise taxes, which is a reason Republicans don’t much like it. But a lot of the Democrats I speak to aren’t particularly confident about winning this debate. The case for a spending cap or balanced budget amendment is intuitive, while the case against, though ultimately more persuasive, is technical, relating to the need for macroeconomic flexibility, the dangers of prizing indirect spending over direct spending, etc. And as you’ll see in Wonkbook today, the GOP is organizing on this early, while Democrats are still milling around, and in some cases, finding themselves accidentally on the other side, as in Claire McCaskill’s support for a spending cap that she didn’t realize would get attached to the debt-ceiling debate.

Your Representatives will be home this week for the recess, and it is important that you hold them accountable for their vote on the budget. How did your Rep vote? Find out at:

Take action now in your state by meeting with your Rep!
Representative Paul Ryan is holding listening sessions next week and we want YOU to attend:

Tuesday, April 26:
  • 9:30am at City Hall, 626 Geneva St, Lake Geneva, WI
  • 11:00am at Village Hall, 108 East Main St, Twin Lakes, WI
  • 1:30pm at Village Hall, 6969 236th Avenue, Paddock Lake, WI
  • 3:00pm at Gateway Technical College, Madrigrano Auditorium, 3520 30th Avenue, Kenosha, WI
Thursday, April 28th:
  • 9:45 am at Village Hall, 123 North River St, Waterford, WI
  • 11:15am at Franklin High School, Gymnasium, 8222 South 51st St, Franklin, WI  *Attendees should park in LOWER/STUDENT LOT
  • 1:30pm at Oak Creek Police Department, 301 West Ryan Road, Oak Creek, WI
  • 3:00pm at Whitnall High School, Auditorium, 5000 South 116th Street, Greenfield, WI
Friday, April 29th:
  • 10:30am,at Veterans Terrace (Liberty Hall), 589 Milwaukee Avenue, Burlington, WI
  • 1:00pm, at Community State Bank, 1500 Main St, Union Grove, WI
  • 2:15pm, at Village Hall, 2801 89th St, Sturtevant, WI
  • 3:45pm, at Caesar Chavez Communtiy Center Gymnasium, 2221 Douglas Ave, Racine, WI
Posted: 22 Apr 2011 04:58 PM PDT
The Department of Health Services (DHS) announced yesterday that it will hold another town hall meeting to gather input on Medicaid budget cutting from consumers, community partners and providers. The meeting will be on Thursday, April 28th from 9:00 AM to 1:00 PM at the Liberty Hall Conference Center in Kimberly (800 Eisenhower Drive).

Quoting from the DHS announcement: “Our Town Hall meeting is designed to collect ideas on efficiencies and cost-savings to meet this amount while improving overall consumer care, streamlining program delivery and stabilizing the program to ensure long-term sustainability.”

As we have noted before, the budget repair bill (which is still in legal limbo because of a court injunction) will give DHS the authority to make sweeping policy changes to achieve savings in the Medicaid and BadgerCare budgets. The Governor’s budget bill recommends the size of those cuts (roughly $500 million in state funding and more than $1 billion in combined state and federal funds), but once Act 10 becomes law the choices about how to make the cuts will be decided by DHS, not by the Legislature. A WCCF analysis summarizes the power that will be transferred to DHS by Act 10.

The department’s town hall meetings provide opportunities for public comment on what DHS should and shouldn’t do to achieve the spending reductions that the budget bill is likely to require. Individuals who are interested in testifying will have up to 3 minutes to share their ideas. If you can’t attend the latest forum or can’t cover all you might like to say in 3 minutes, you can submit your comments and recommendations electronically at

Although we don’t know specifically what DHS may be contemplating to achieve the cuts the Governor has recommended, Secretary Smith has shed at least a little light on some of the options that he appears to favor. Some of his ideas are outlined in his testimony before the Joint Finance Committee earlier this month. Courtesy of Wisconsin Eye, you can watch Smith’s testimony and the Q and A portion of his appearance by clicking here.

The Wisconsin Department of Health Services is having another Town Hall meeting for Wisconsinites to relate their concerns and ideas about the state’s Medical Assistance programs, this time in Kimberly, Wisconsin on Thursday, April 28.  Please see the exact time and location below.  DHS has said that they are mostly interested in cost-saving measures, but this is another great opportunity to speak up and let them know just how important and vital programs like BadgerCare Plus are to the families of Wisconsin
Liberty Hall Conference Center
800 Eisenhower Drive
Kimberly, WI 54136

Meeting Rooms 1, 2, & 3
Thursday April 28, 2011
9:00 A.M. - 1:00 P.M
Please see this announcement for more details:

Can’t make it to the meeting?  DHS is also collecting feedback online:

Medicaid's Role in the Health Benefits Exchange: A Road Map for States
National Academy for State Health Policy
Bachrach, Deborah; Patricia Boozang; Melinda J. Dutton
Examines issues for integrating Medicaid into the administration, operation, and coverage continuum of insurance exchanges. Discusses eligibility, enrollment, and outreach; contracting, standards, and requirements; benefits design; and infrastructure.

Thursday, April 14, 2011

New Information

Received these emails today.

Alert: Vote on Federal Budget Blueprint on Friday, April 15...

Sara Finger of WI Alliance for Women's Health,                                                 

Rep. Paul Ryan from Wisconsin has proposed a federal budget resolution
that could have significant impact on people with disabilities. The
resolution is a guide for how Congress should put together the budget. It
is not the final budget, but it is still very important because it
provides direction to Congress. Some features include:

•    Medicaid: Cuts $1.4 trillion over 10 years, reducing federal support
about 33% and shifting costs to low-income consumers, including many
people with disabilities
. The proposed plan converts Medicaid to a block
which will cap funding regardless of how much health care costs
increase with inflation.

•    Medicare: Replaces Medicare with a voucher program, shifting service
costs to the beneficiaries, almost doubling the amount that individuals
pay out of pocket for their ongoing health care.

•    Health Care Reform: Repeals and defunds the Affordable Care Act signed
into law by President Obama.

•    Discretionary Programs (includes funding for the DAWN network):
Eliminates most federal government programs outside of health care,
Social Security, and defense over time as the cuts are so deep.

•    Taxes: Over the course of 10 years, the $4.3 trillion from all of
these cuts will be used to provide $4.2 trillion in tax cuts to
upper-income individuals and corporations.

What does this mean for people with disabilities? There would be no
guarantee of services. People with disabilities could be denied:
•    health insurance coverage
•    home and community based services
•    supportive housing
•    job training
•    education
•    transportation
•    and much, much more

States could return to the use of institutions to save money. This would
be cheaper under the Ryan plan since state institutions will no longer
have to meet the quality standards currently imposed by the Medicaid
program. Also, waiting lists for home- and community-based services could
grow much longer.

The House of Representatives will vote on this plan on Friday, April 15.
If you want to voice your opinion about this plan to your Congressional
Representative, call toll free at 1-866-922-4970 (TTY 202-225-1904) and
ask for your Representative's office. Call today to make your opinion
heard before the vote.

National Health Law Program:

Although the Medicaid program grants flexibility to states to provide a variety of services within their jurisdictions, today the Department of Health and Human Services (HHS) announced four initiatives that support new practices for providing cost-efficient and coordinated care for Medicaid and Medicare enrollees.  The four initiatives are:
·         additional funding in 15 states for coordinated care services of dually eligible enrollees (in Medicaid and Medicare);
·         new rules on state flexibility to support appropriate community based services for individuals with disabilities, as opposed to institutional care;
·         an increase in the federal matching rate to 90 percent to states (from 50 percent) to upgrade information technology systems to enroll eligible individuals in Medicaid or CHIP; and
·         an approved 1115 demonstration for New Jersey that will provide increased care coordination and coverage for almost 70,000 uninsured residents.

More details on the initiatives can be found in the HHS Press Release below:

Thursday, April 14, 2011 (202) 690-6343

New flexibility for states to improve Medicaid and implement innovative practices
New rules will make Medicaid more flexible and efficient,
helping states provide better care and lower costs

The U.S. Department of Health and Human Services (HHS) today announced four initiatives to give states more flexibility to adopt innovative new practices and provide better, more coordinated care for people with Medicaid and Medicare while helping reduce costs for states and families. The initiatives support the Obama administration’s work to make Medicaid more flexible and efficient and to address long-term cost growth. Several of the announcements also help implement provisions of the Affordable Care Act. Today HHS announced:

• Fifteen states will receive federal funding to develop better ways to coordinate care for people with Medicare and Medicaid coverage, also known as dual eligibles, who often have complex and costly health care needs.
• All states will receive increased flexibility to provide home and community-based services for more people living with disabilities.
• All states are eligible to receive more money to develop simpler and more efficient information technology (IT) systems to modernize Medicaid enrollment.
• A proposal by the state of New Jersey for flexibility to expand health coverage for nearly 70,000 low-income residents has been approved.

“Medicaid programs provide health coverage for millions of low-income Americans who otherwise would lack access to health care,” said HHS Secretary Kathleen Sebelius. “With these new resources and flexibilities, states will have new options to make their Medicaid programs work better for the people they serve, while helping lower their costs.”

Coordinated Care for People with Medicare and Medicaid

Under a new initiative funded by the Affordable Care Act, 15 states will receive up to $1 million each to develop new ways to meet the often complex and costly medical needs of the approximately nine million Americans who are eligible for both the Medicare and Medicaid programs, known as “dual eligibles.” The goal of the program is to eliminate duplication of services for these patients, expand access to needed care and improve the lives of dual eligibles, while lowering costs. The new Federal Coordinated Health Care Office, or the Duals Office, at the Centers for Medicare & Medicaid Services (CMS), was created by the Affordable Care Act to improve care for dual eligibles and will work with the states to implement the top strategies to coordinate primary, acute, behavioral and long-term supports and services for dual eligibles, improving quality and lowering costs.

The 15 states that will receive these funds are California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington and Wisconsin.

“Beneficiaries who are in both Medicare and Medicaid can face different benefit plans, different rules for how to get those benefits and potential conflicts in care plans among providers who do not coordinate with each other,” said Donald M. Berwick, M.D., administrator of CMS. “This can be disastrous for those beneficiaries who are most vulnerable and in need of help.”

Helping People with Disabilities Live in their Communities

CMS proposed new rules today giving states new flexibility for their programs to help people with disabilities choose to live in their communities rather than in institutions. The proposed rules reduce administrative barriers for states seeking to help multiple populations, which may include seniors and/or people with different types of disabilities. They will also allow individuals to participate in the design of their own array of services and supports, including such things as personal care and respite services for caregivers.

“These long awaited rules will help people living with disabilities realize the promise of the ADA to live in the least restrictive environments possible for them—like their own homes,” said Henry Claypool, director of the Office on Disability at HHS. “With these new tools as well as incentives included in the Affordable Care Act, states, working closely with advocacy groups, beneficiaries, and other stakeholders, can more easily develop effective plans to improve options for people with disabilities. We hope states will take advantage of this new flexibility.”

The proposed rule, CMS-2296-P, can be found at

Developing and Upgrading Medicaid IT Enrollment Systems

New rules issued today will provide 90-percent of the cost for states to develop and upgrade their IT systems to help people enroll in Medicaid or the Children’s Health Insurance Program (CHIP) – and 75-percent of ongoing operational costs. This increase over the previous federal matching rate of 50-percent will help states prepare for the Medicaid improvements and expansion that will come in 2014 from the Affordable Care Act, when many more Americans will be eligible for these programs, and to coordinate enrollment with the Exchanges. The rules establish performance standards for the improved eligibility systems to promote greater efficiency and a more consumer-friendly enrollment process.

The final regulation, CMS-2346-F, can be found at

Expanding Health Coverage in New Jersey

HHS Secretary Kathleen Sebelius today approved a Section 1115 demonstration for New Jersey that will expand health coverage to nearly 70,000 uninsured, low-income people through the Work First New Jersey program. In addition, the state will increase care coordination to improve health outcomes for participants in the program.
“This demonstration is yet another example of the many flexibilities states have to adapt their Medicaid programs to better serve their residents,” said Secretary Sebelius. “I want to commend New Jersey for expanding coverage to people in need.”

For more information about these announcements, visit

Note: All HHS press releases, fact sheets and other press materials are available at

Deborah A. Reid
Senior Attorney
National Health Law Program (NHeLP)
1444 I Street, N.W., 11th Floor
Washington, DC  20005
"Securing Health Rights for Those in Need"