Monday, October 31, 2011

DHS Rushes Process to Take Away Health Care Coverage from Working Families

Submits Waiver After Inadequate Time for Public Input and too Many Unanswered Questions

Madison – Late this afternoon, the Department of Health Services (DHS) delivered to the Joint Finance Committee a proposal to increase costs, make eligibility and enrollment more difficult, and decrease benefits for families in the BadgerCare and Medicaid program. The Save BadgerCare Coalition is disappointed with the substance of the proposal to cut over $500 million, as well as process in which DHS brought it to the Joint Finance Committee. Despite holding two town hall meetings last week where attendees overwhelmingly expressed opposition, anxiety and frustration over the impending cuts, DHS continued to rushing through its plans to kick working families off of their health care coverage, a decision that will be disastrous for working families and Wisconsin’s small businesses.

“Working families across Wisconsin need sufficient time and information to digest the drastic changes being proposed,” said Sara Finger, Executive Director of the Wisconsin Alliance for Women’s Health and Save BadgerCare Coalition Coordinator. “The public hearings arranged by the Department were insufficient in answering the scores of unanswered questions on the proposals and truly addressing enrollee concerns. This was an irresponsible and disrespectful way to make these kind of critical policy decisions”

The provisions granting unprecedented authority to DHS to make changes to Medicaid and BadgerCare with limited legislative oversight were made in the budget this summer, however it took until September 30th for any details of the plans to make half a billion dollars in cuts to be made public. Wisconsinites who depend on BadgerCare were asked for input on proposals with a significant lack of detail, and according to scoring by a well-known measure of health literacy, more difficult to read than the Harvard Law Review.

DHS put themselves, and over 1.1 million Wisconsinites who depend on BadgerCare, in a no-win situation with this proposal. Before the Joint Finance Committee is a waiver of the “maintenance of effort” provisions of the federal health reform law, which restricts state’s ability to reduce eligibility or made changes that suppress enrollment. If this waiver is not granted by December 31, 2011, the budget states that DHS must cut approximately 53,000 adults off the program. Both the waiver, and the action mandated by the budget if the waiver is not approved, would effectively increase the numbers of uninsured Wisconsinites – which shifts costs and increases uncompensated care.

“We need a balanced approach to reforming and streamlining Medicaid,” said Ken Taylor, Executive Director of the Wisconsin Council on Children and Families, a lead coalition member.  “With so much at stake for Wisconsin families, we need to consider alternatives to this DHS plan, ones that will not increase the number of uninsured Wisconsinites.”

The Coalition finds it unacceptable that these remarkably effective—and cost-effective—programs are at risk of being gutted on such short notice, while alternative methods for increasing efficiencies and revenues, and finding cost savings have not even been seriously entertained. There are better alternatives in the legislature; to remove the impossible bind DHS has put themselves in with regard to the timeline and elimination of coverage for 53,000 adults. Save BadgerCare will continue to participate in public hearings with legislators across the state, including La Crosse today, and Wausau, Oshkosh, Eau Claire, and Green Bay in the coming weeks, to solicit further public input and provide an opportunity for residents to learn more about the proposed cuts.

This Is About To Get Uglier

Saturday, October 29, 2011

Rebuild the American Dream Teach - In

Dear friend,
How did 1% of the population end up with 40% of the wealth? Why have middle class wages been stagnant while America has grown richer by the year? And, most importantly, what can we, the 99%, do about it?
These are important questions worth discussing. So we're organizing "How the 1% Crashed the Economy" teach-ins across the country on November 9th. In living rooms, libraries, and community centers nationwide, we'll dig into the roots of the inequality in our country—and what we can do together to fix it.

Yes, I can host a teach-in.

You don't need to be an expert—we've worked with top progressive economists to put together a simple presentation and discussion that anyone can lead, focused on exactly what Wall Street did to crash our economy. Can you volunteer?

Yes, I can lead a teach-in on Nov. 9.

It's surprisingly easy. All you need is a space where folks can gather (anywhere from your living room to the local library would be great), a computer screen to display the presentation, and willingness to guide the conversation.

After you sign up to host, we will set you up with a complete set of slides and materials, so you can use it "straight out of the box." But we also invite you to add your ideas and make it your own. For example, maybe you know important facts or trends about the local economy in your area that ought to be discussed.

And once you confirm your teach-in we'll invite other Rebuild the Dream members to attend. It's a great way to start the real conversations we so desperately need in our country. Click here if you can host in Manitowoc on Nov. 9:
Thank you for being a part of, and believing in, this movement.
–Natalie, Van, Billy, Jim, Ian, Somer, and the rest of the Rebuild the Dream Innovation Fund team

La Crosse: Shilling holds hearing on BadgerCare cuts

Monday, October 24, 2011

The Wisconsin Department of Health Services (DHS) released their plans to cut over $500 million from our state's Medicaid Program including BadgerCare - yet DHS Deputy Secretary Kitty Rhoades, said they were just "cutting ineffiencies"!  In response, I think we should take some new photo petitions with signs that read "I am an inefficiency!" Have fun with it and get creative but let's show Miss Rhoades what "inefficiencies" really look like!

Save BadgerCare Photo Petition Instructions

  1. Take a picture showing that you want to Save BadgerCare. You can print and use one of our signs (see attached), or you can get creative and make your own that explains why BadgerCare is important to you.
  2. Email your photo as an attachment to Make sure you include your name, city and zip code.
  3. We'll post your photo on our site and use it to show our elected leaders that their constituents support and want to protect BadgerCare and Medicaid when policy decisions are made in the next month.
  4. Forward along to friends, family, colleagues and neighbors.  We're aiming to collect at least 500 images by the end of October!
Be sure to check out some of our first photos by linking here and check back often to see our growing collection of Save BadgerCare supporters!

Thank you!

From State Senator Joe Leibham

~ Health Care Tax Relief Bill Moves Forward ~
I am pleased to report that an important health care tax relief bill, that I have co-sponsored, was recently passed by the State Senate and will hopefully make its way to the desk of Governor Scott Walker for his consideration in the near future.  I co-sponsored the bill at the request of numerous local constituents who contacted me and asked me to provide leadership on this important tax relief initiative.
The proposal, known as Senate Bill (SB) 203 & Assembly Bill (AB) 277 will provide a state individual income tax exclusion for the value of an employer-provided health insurance benefit that is extended to an employee’s non-dependent child who is under the age of 27 years.  The need for this tax reform came about as a result of the 2010 passage of the federal Affordable Health Care Act which allows non-dependent children to remain on a parents health insurance plan until they turn 27 years old.
Numerous constituents have contacted me who recently received information from their employer that their income would be taxed on the fair market value of the health insurance coverage extended to their non-dependant children.  For many families, this will equate to thousands of dollars of additional tax liability.
While Wisconsin tax law currently excludes the value of an employer-provided health insurance benefit for an employee, their spouse and dependent children, SB 203/AB 277 are needed to extend this exclusion to non-dependant children.  The proposal is written so that the new tax exclusion would be retroactive to January 1, 2011 so the change would cover all of tax year 2011 and future tax years.
While this tax exclusion will help many Wisconsin families and make health insurance for young adults more affordable and accessible, it will mean that our state will receive less tax revenue.  The state Department of Revenue (DOR) estimates that this new tax policy will reduce state tax revenue by $4.5 million over the 2011-13 biennium. 
Again, based on the requests I received from numerous area constituents and on my overall goal to reduce the tax burden placed on Wisconsin’s middle class families, I have enjoyed providing leadership on and support for this proposal that will make health care for young adults more affordable and available. 
For more information on the proposal link to:

Please join the Center for American Progress for a special presentation:

Maintaining Health Coverage after Life Transitions

October 27, 2011, 12:00pm – 1:30pm
Admission is free.

RSVP to attend this event


Watch Live Online

Opening Remarks
Topher Spiro, Managing Director for Health Policy, Center for American Progress
Ken Jacobs, UC Berkeley Labor Center
Beth Capell, Health Access California
Mark Iwry, Senior Advisor to the Secretary and Deputy Assistant Secretary for Retirement and Health Policy, U.S. Department of the Treasury
Helen Morrison, Deputy Benefits Tax Counsel, U.S. Department of the Treasury
Ann O'Leary, UC Berkeley School of Law
Nearly half of all Americans can be expected to go without coverage at least once over a ten year period. Even small bouts of un-insurance can have negative outcomes on individuals’ health and financial stability. Key triggers of loss of coverage include: unemployment, reduction in work hours, changing jobs, moving and divorce. COBRA benefits are currently the main option for people who lose job-based coverage, but take-up rates are low due to high costs at a time of reduced income. The new health insurance exchanges have the potential to provide seamless coverage for those who lose employer-sponsored insurance due to life transitions. Achieving this full potential will require action by the federal and state entities charged with implementing the Affordable Care Act (ACA).
At this event, a panel of experts will present data from a new policy brief to be released at the event and provide recommendations for the federal government and the states on ACA implementation to maximize coverage after life transitions.

October 27, 2011, 12:00pm – 1:30pm
WATCH this event via live video on our website
*Video available LIVE and after the event has occurred.

To attend in person, RSVP is required.
Space is extremely limited.
Seating is on a first-come, first-served basis and not guaranteed.

Center for American Progress
1333 H St. NW, 10th Floor
Washington, DC 20005

Map & Directions
Nearest Metro: Blue/Orange Line to McPherson Square or Red Line to Metro Center
For more information, call 202-682-1611.

Saturday, October 22, 2011

Pudgy Politicians

You know whenever I see a pudgy politicians it makes me angry! Do you know why? Because I know they are being wined and dined in order to curry political favors. They get to eat meals in places most of us never will and enjoy the benefits that come with rubbing elbows with those that are out to destroy the social safety nets. Then when their gluttonous lifestyle catches up to them, we the taxpayers foot their medical bills, after they have taken away health care for thousands, it makes me sick!

Residents voice concerns about proposed BadgerCare cuts

Kristyna Wentz-Graff

Dennis Smith, secretary of the Department of Health Services, receives 2,000 signatures from Citizen Action of Wisconsin at a public hearing Friday in West Allis as Deputy Secretary Kitty Rhoades looks on. The signatures are from residents concerned about proposed health cuts. MORE PHOTOS

State hears comments on plans to trim Medicaid budget

Photo Gallery
West Allis - Concern, frustration and, at times, anger characterized the overall mood at a town-hall meeting Friday on the state's plan to trim an estimated $554 million over two years from the BadgerCare Plus and Medicaid budget.
The Department of Health Services this month released dozens of proposed changes in the programs that provide health coverage to about one in five people in Wisconsin, ranging from children in low-income families to adults with severe disabilities to people living in nursing homes.
The changes are designed to close the state's budget shortfall while maintaining coverage for people, said Dennis Smith, secretary of the Department of Health Services. They also would have minimal effect on people who are disabled or elderly and impoverished, Smith said.
But Smith and Kitty Rhoades, deputy secretary, on Friday encountered more than a little wariness at the town hall meeting held at the Tommy G. Thompson Youth Center at State Fair Park. The hearing was scheduled to last five hours.
The proposed changes will be reviewed by the Legislature's Joint Finance Committee and also will require the federal government's approval.
They are projected to generate savings as small as $200,000 by improving the coordination of care for people with HIV/AIDS and as large as $105.9 million by freezing enrollment in the Family Care and other programs designed to help keep people who are disabled or elderly out of nursing homes.
The temporary cap on enrolling in Family Care generated the most comments Friday. Several speakers noted that the waiting lists were beginning to grow.
One of the most controversial proposals is to limit the benefits of an estimated 215,000 people now covered by BadgerCare Plus. That program covers families with children younger than 19 and household incomes below 200% of the federal poverty level - or $44,700 for a family of four.
Under the department's proposal, people with incomes from 100% to 200% of the federal poverty level - $22,350 to $44,700 for that family of four - would be put in a plan with limited coverage for prescription drugs, co-pays and other limits.
The coverage would be comparable to what people receive when they have health insurance through an employer, Smith said.
About half of the adults with incomes in that range now get health insurance through an employer, according to researchers at the University of Wisconsin.
The department also has proposed requiring people with incomes above 150% of the federal poverty level, or $33,525 for a family of four, to pay 5% of household income for coverage. "We are asking individuals to pay what we think is a fair value for what they receive," Smith said.
Smith said most people who get insurance through an employer pay an average of 15% of the premium.
The national averages are actually higher. But Smith is comparing two separate figures - the percent of a premium is not the same as percent of household income.
The proposed increase means that a single mother with two children who makes just under $28,000 would pay $116 a month instead of $10 a month in premiums.
"The problem is the families we are talking about already are stretched thin," said Barbara Beckert, of Disability Rights Wisconsin.
The state also has not done an analysis of the number of people who could lose coverage because of the increase in premiums, she said.
Her main concern is the unintended consequences from the proposed changes.
But Beckert also understands the dilemma facing the department as it works to find more than $500 million in savings. "There are a lot of difficult choices here."
But that didn't lessen the frustration among some who criticized the administration's and Legislature's priorities in cutting programs.
"You know in your hearts it is going make it harder for people," said Devaci Williams, 16.

Friday, October 21, 2011

La Crosse Area Legislators to Hold
Public Hearing on Proposed Medicaid Cuts
Opportunity to hear from constituents regarding Governor Walker’s plans to reduce health care benefits


WAUSAU – Sen. Jennifer Shilling (D – Wausau) announced today that she will host a budget hearing along with other legislators from the LaCrosse Area. 

This hearing is part of a series of events being hosted by Democrats statewide in response to the Department of Health’s plan to make $554 million in cuts to the state’s health care programs for eligible seniors, children, families and people with disabilities.  Governor Walker and legislative republicans gave $2.3 billion in tax breaks to large corporations and special interests in the state budget, and now they are looking to make up the money by taking it out on people whose needs are even greater doing these difficult economic times.

DHS held hearings in Madison and Milwaukee, but it is important to hear from people in all corners of the state.  This proposal will have significant impact on the affordability of health care and critical health services available to tens of thousands of Wisconsin residents. 

A brief presentation on the proposed cuts will start of the hearing, and then the public is encouraged to share their personal stories and opinions.

WHAT:                       Public Hearing on Medicaid Cuts

WHO (invited):           Sen. Jennifer Shilling
                                    Rep. Chris Danou
                                    Rep. Lee Nerison

WHEN:                       Friday, October 21st
                                    4:00 p.m. – 6:00 p.m.

WHERE:                     UW – La Crosse (1725 State Street)
                                    Cartwright Center, Room 337

This event is open to the public and the press.  If you would like more information about this event, please contact Sen. Shilling’s office.

DHS Rushes Process to Take Away Health Care Coverage from Working Families

Denies Adequate Time to Review Complex Proposals and Answer Growing List of Questions

The Save BadgerCare Coalition is once again expressing frustration with the timeline and process the Department of Health Services (DHS) is using to make drastic changes to Wisconsin’s successful and cost-effective Medicaid program.  Despite holding two town hall meetings this week where overwhelming opposition, anxiety, and frustration was expressed, DHS is rushing through their plans to kick working families off of their health care coverage. 

According to communication from DHS today, they plan to submit their formal proposal next week to the Joint Finance Committee.  If this is the case, public input opportunities will soon end, questions will remained unanswered and individuals with so much to lose will never have a chance to be heard.

Despite the budget being passed this summer, the Administration waited until September 30th to reveal an overview of their plans to make cuts to BadgerCare Plus and Medicaid totaling half a billion dollars. We now have a better idea of how DHS plans to cut $554 million from these programs, however, the DHS summary document still leaves many questions unanswered, which makes it difficult for people to comment on the plans. Enclosed is a list of some of the significant questions relating to the proposed BadgerCare changes, which may be devastating to the health and economic security of Wisconsin families.

While many critical details of DHS’s plan remain unknown, their proposal includes significant premium increases, benefit reductions and other changes that reduce availability and accessibility of services for enrollees, and increase costs for struggling families, the elderly, and people with disabilities. This unbalanced approach essentially places the burden onto individuals and families who are already struggling. It also shifts costs to small businesses and others in the private health insurance market that will end up paying for the plan’s inevitable increase in the number of uninsured, and their uncompensated health care at emergency rooms.

At Wednesday’s town hall meeting DHS Secretary Dennis Smith expressed his confidence in the timeline and communication methods use to share their plans to reform Medicaid.  Yet, according to health literacy standards, the DHS proposals posted on their website get a Flesch-Kincaid Reading Ease Score of 28.0 – compared to Readers Digest readability score of 65, Time magazine score of 52 and the Harvard Law Review score of low 30’s.  The higher the scores, the easier the document is to read, and the DHS documents are harder to read than the Harvard Law Review. 

“With such little time and with such complicated proposals, DHS appears to be deliberately rushing through drastic cuts to our state’s prized Medicaid program,” said Sara Finger, Save BadgerCare Coalition coordinator.  “With so much at stake for the Wisconsin’s health and economy, this is an irresponsible and disrespectful way to make these kind of critical policy decisions.”

The Coalition finds it unacceptable that these remarkably effective—and cost-effective—programs are at risk of being gutted on such short notice and with so little information, while measures for reducing the size of the cuts by identifying additional revenue and other available options have not been seriously entertained.


Outstanding List of Questions about the Proposed Changes to BadgerCare

Restricting Eligibility for People with Access to Private Coverage (if that coverage costs less than 9.5% of family income)
·         At what income level does this restriction apply to parents and to children?
·         How many children and parents does the department expect will lose their BadgerCare coverage because of this change?
·         Will this requirement also be applied to pregnant women?
·         For a family, will the 9.5% standard be determined based on the cost of an employer’s family plan, or the cost of an individual plan?
·         Is it based solely on the employee’s share of premiums, or also on other cost-sharing (such as co-pays)?
·         In addition to employer-sponsored coverage, what other types of coverage does the 9.5% standard apply to, and what’s the minimum threshold for the quality of a plan?
·         Will the proposed changes affect the current spend-down policy (which provides BadgerCare eligibility for children with high medical costs that reduce the family income to less than 150% of FPL)?
·         Will the crowd-out policy change apply to a grandparent who is a child’s primary caretaker, and therefore is now eligible for Medicaid, if the grandparent is enrolled in or has access to Medicare? Will it affect other “dual eligibles”?

Ending Transitional Medicaid (TMA)
·         Will this change adversely affect people who have temporary increases in their income?
·         How many people will be affected, and how many of those are expected to lose their BadgerCare eligibility? How many of those are children?

Broadening Definition of Family Unit
·         The proposal counts the income of other adults in the household, even if they are unrelated to the program participant and ineligible for coverage. Will it also count them in the family size (to reflect that some or all of their income is needed for the household’s higher costs)? (What about unmarried adults living together, each with their own kids?)
·         How many people does DHS estimate will lose eligibility because of this change?
·         In light of court cases relating to how the family unit is defined for purposes of determining household size, could CMS allow this change (even if Congress repealed the MOE requirements)?
·         Will the new family unit definition and income calculation be consistent with the income definition used in the Affordable Care Act and the proposed ACA regulations?
·         Is it possible to make the same change in family composition for purposes of determining eligibility for other programs handled through the CARES system? If not, how much additional work does that cause for caseworkers, and what are the implications for the creation of an online portal in 2014 that coordinates Medicaid, exchange eligibility and other public benefits?

Increasing Premiums
·         Does the department intend to increase premiums to 5% for all families, including families that only need child coverage (if, for example, the parent has coverage through an employer plan that costs less than 9.5% of household income, but which doesn’t cover children).
·         Is it the department’s intent to also establish a 5% premium for the BadgerCare Plus Core Plan? If so, does that require a Core Plan waiver, in addition to a waiver of MOE requirements?
·         Will there continue to be a cap that prevents the 5% premium from exceeding the average cost of the coverage? (This is probably only relevant for child-only coverage for families well above the 200% of poverty level.)

12-Month Suspension of Eligibility for Failing to Pay a Premium
·         Are there any good cause exceptions?
·         How many parents were suspended in 2010? If the current 6-month suspension had applied then to children between 150% and 200% of poverty (rather than just to their parents), how many children would have lost coverage?

Ending Retroactive Eligibility
·         If this change had taken effect at the beginning of 2010, how many people would have been affected and what would have been the total (all funds) savings?

Outstanding List of Questions about the Proposed Changes to BadgerCare

Ending Presumptive Eligibility
·         Would this change apply to pregnant women, as well as children?
·         Will it apply to kids being enrolled in the Katie Beckett program?
·         If this change had been in effect in 2010, how many people would have been affected and how much would the state have saved (in up front savings – without accounting for potential costs of poorer birth outcomes from delays in the initiation of prenatal care)?

Requiring Documentation of State Residency
·         What sort of documentation or verification will be required?
·         How will this be handled for homeless people?
·         How will this affect on-line enrollment now and when the new online portal is initiated in 2014? Will people have to fax in some sort of document verifying their residency?
·         What will this requirement mean for the department’s goal of achieving “real-time” eligibility determinations?
·         Will people who enroll for benefits through ACCESS be able to initiate their Food Share benefits during the period while DHS is waiting to get a fax or other documentation of their residency?
·         Has the department estimated how much this will increase the number of county and state (or private) workers needed in the income maintenance system?

Restricting Eligibility of Young Adults
·         Under what circumstances will this apply? For all young adults, or does there have to be some sort of determination that a parent has coverage that is subject to the federal law allowing parents to include adult children in their family coverage?
·         Does it apply if a young adult’s parents live outside Wisconsin or in a different part of Wisconsin – when the child isn’t within the service area of a parent’s managed care plan?
·         Will it apply to employed parents that have offers of a family plan, regardless of whether they currently participate in that plan, and regardless of their income (and capacity to afford the coverage)?
·         Does it apply to an adjudicated parent who never had custody or any relationship with the child?
·         Does it apply to step-parents who may have helped raise the child?
·         Will this change be sunsetted if all of the Affordable Care Act is found unconstitutional?
·         Will this apply to family planning waiver services? How about Medicaid eligibility for young adults with disabilities?
·         How will this requirement affect the online enrollment system and the department’s goal of achieving “real-time” eligibility determinations?

Speeding up Eligibility Terminations
·         When will the cut-off of eligibility occur (only at the end of a month, semi-monthly, at the end of a week, or on whatever date DHS determines the person doesn’t meet eligibility standards)?
·         If terminations occur before the end of the month (when, for example, someone gets a raise), will the department send the family a refund of part of their premium?
·         Will eligibility be terminated even if the enrollee contests the accuracy of the information the department is relying on and requests a fair hearing?
·         How many people does DHS expect this change to affect, and how much is it expected to save?

Alternate Benchmark Plan
·         Will there be one plan (full Medicaid benefits) for everyone under the poverty level and a different plan for everyone over the poverty level?
·         How will the new “alternate” Benchmark Plan compare to the current Benchmark plan?
·         What will the new co-pays be?

All about ALEC Forum

Wednesday, October 19, 2011

Proposed Wisconsin Medicaid cuts called 'scary stuff'

Advocates for the poor, elderly and others covered by a host of Medicaid programs spoke out against the proposal that would lead to increased premiums and the shifting of hundreds of thousands of people into less costly state or private plans.
"This is scary stuff," said Karen Foxgrover, a volunteer advocate for people with disabilities. "I understand what you're saying that these are necessary cuts, but it doesn't make it any easier to swallow."
The changes are needed given the rising cost, loss of federal money and exploding enrollment growth in various Medicaid programs, which serve roughly 1.1 million Wisconsin residents, or one in five people.
"Doing nothing is not an option," DHS Secretary Dennis Smith said at the outset of the hearing.
Drew Hanson, 44, of Madison said he worried he couldn't afford insurance through the state's BadgerCare program for his 3-year-old daughter if premiums increased 5 percent as proposed. Hanson said he buys private catastrophic health insurance for himself and works part-time so he can be home to care for his daughter after his wife died two years ago.
"We're on a razor thin family budget," Hanson told Smith and Deputy Secretary Kitty Rhoades. Rising costs would force him to go back to full time work and not spend time with his daughter, Hanson said.
"With all due respect, I don't think it's fair to my daughter to suffer any more than she already has," he said.
The state Department of Health Services' plan calls for shifting more than 200,000 families enrolled in BadgerCare Plus into so-called benchmark plans that have fewer benefits and don't cost the state as much.
Doing that requires a federal waiver. Without it, the state plans to increase income eligibility requirements which would force more than 50,000 people out of the program through raising income eligibility requirements.

Without the waiver, the income cut off would be raised from 200 percent of the federal poverty level to 133 percent. Currently, a family of three earning up to $37,060 is eligible. Without the waiver, the cut off would drop to $24,645 for the same family.
BadgerCare Plus is designed to provide insurance to poor children, pregnant women and poor adults. It is funded with a combination of state and federal money.
The department also is proposing that premiums increase up to 5 percent for families making more than 150 percent of the federal poverty level.
The public hasn't had enough time to review or understand the complex proposed cuts, said Sara Finger, coordinator of the Save BadgerCare Coalition comprised of numerous health care providers and consumers, public policy experts, disability rights advocates, and others. The proposed cuts were made public Sept. 30 and comments could be submitted on the website since then. Wednesday's hearing was the first of two, with the final one set for Friday in Milwaukee.
Rhoades, the agency's deputy secretary, said before the hearing that the plan was to submit its final proposal to the Legislature's budget committee as early as Monday. Smith said the federal waiver would be sought as soon as possible once the budget committee signs off on it.
The Republican co-chairs of the Legislature's budget committee have called the agency's recommendations encouraging. Democratic lawmakers who don't have the votes to stop approval have said the changes would hurt working families.
The federal waiver would also give the state permission to declare that individuals and families would no longer be eligible if they have access to affordable employer-based insurance plans.
The waiver also would clear the way for the state to require young adults between the ages of 19 and 26 to join their parents' or other private insurance plans. DHS estimates that would move about 6,500 people off of state-funded Medicaid plans.
None of the changes being sought would affect SeniorCare, the state's popular prescription drug discount program for seniors.
The department's plan is designed to save more than $500 million by mid-2013.

Friday, October 14, 2011

Overview of Consequences of Wisconsin DHS Proposal to cut $554 million from Medicaid

On Friday, September 30, 2011, DHS released plans to help cut $554 million from Medicaid. Key aspects of the proposal require
federal approval through a waiver from the Centers for Medicare & Medicaid Services (CMS). This is a preliminary assessment of the
likely consequences of the proposed changes relating to BadgerCare Plus, with regard to the “maintenance of effort” waiver portion of
the DHS proposals and the benchmark plan. Overview and analysis of the other proposals will be forthcoming.



Increases BadgerCare
premiums up to 5% of
household incomes

 Increases out-of-pocket costs for Wisconsin families, making health care coverage

The proposal would increase premiums to 5% of income for many families above 150% of the
federal poverty level and would expand the premiums to children’s coverage (which would affect
child-only coverage for some of the nearly 44,000 enrolled children between 150% and 200% of
the poverty level). For low-income families who are often living paycheck to paycheck, higher
premiums will frequently mean loss of coverage and becoming uninsured. A single mother with
two children making just under $28,000 per year currently pays about $10 a month in premiums
but under the benchmark plan proposal would pay up to $116 a month.

Denies BadgerCare to
individuals who are offered
high cost employer-
sponsored insurance that is
deemed affordable by
lowered DHS standards

Makes it harder for workers to afford and access the health care they and their families need.

Many low-wage workers may be offered employer-sponsored insurance, but it’s often
unaffordable. DHS proposes denying BadgerCare to workers who are offered employer
insurance, even if they can’t afford it. This will result in individuals and families becoming
uninsured due to financial barriers. The proposal by DHS deems employer coverage “affordable”
if it costs less than 9.5% of household income, whether it covers only the employee or the entire
family. For example, a family of 5 that currently pays $54 a month in BadgerCare premiums
could instead pay $330 for an employer-sponsored insurance plan premium – an increase of
$3,312 per year.

Requires young adults from
the ages of 19 through 26
to be covered under their
parents’ health insurance

Kicks young adults ages 19-26 off BadgerCare Plus.

The Affordable Care Act ensures that young adults have the option of staying on their parent’s
insurance until they are 26. This plan mandates coverage under parent’s insurance by making
young adult ineligible for BadgerCare Plus. It presumes all young adults have parents who are
willing and able to add them to their private insurance, and that the adult child lives in the same
area as their parent.

Eliminates presumptive

Delays care for eligible children and/or pregnant women when they need it most.

By making it harder for women to enroll in BadgerCare through presumptive eligibility, women
will be delayed from getting cost-effective prenatal care early in their pregnancy and interrupt
the continuity of care that gives babies a better chance at a healthy start.

Drastically increases
penalty time for individual
who misses a BadgerCare
premium payment

Doubles amount of time individuals and families are suspended from health care coverage
through BadgerCare.

In light of premium increases, there will likely be more missed premium payment due to higher
costs. This will result in many people being kicked off BadgerCare for a year, including many
children (who now aren’t generally suspended, because premiums don’t apply to them).

Forces all individuals above
100% FPL into a more
expensive Benchmark plan

Shifts over 200,000 beneficiaries into a higher cost-sharing and lower benefit plan.

Proposals call for moving all families and individuals above the poverty level into an “alternate
Benchmark plan”, which would cost more and cover less – though we still don’t know the details.
The reduced scope of covered services is likely to preclude some of the most vulnerable
beneficiaries from getting the health care they need. Cost-sharing from co-pays and deductibles
would be increased, up to a cap of 5% of household income, and that is apparently on top of
increased premiums (also up to 5% of income) for families above 150% of the poverty level.

Ends retroactive eligibility

Increases amount of uncompensated care and increases likelihood of health care bankruptcy.

This would end the current practice of covering eligible individuals for up to three months before
applying. For some with very expensive hospitalizations, these costs may bankrupt the person.

Changes the definition of
the family unit

Counts the income of all adults living in the household in determining eligibility (except

Counts the income of other adults living in the household (e.g., siblings, roommates, boyfriends
or girlfriends), but appears not to count them on the expense side of the ledger. This is likely to
put many BadgerCare enrollees over the income limits, and raise premiums for many others.



Assumes individuals no
longer eligible for
BadgerCare can afford
private health care

Creates higher health care costs with cost-shifting.

With people losing BadgerCare coverage, and thus joining the ranks of the uninsured, this will
result in cost shifting that will make health care more expensive for every Wisconsin family and
small businesses. That loss of coverage among low-income households is also likely to lead to
unfavorable outcomes for providers, who might face increased use of emergency rooms, a loss of
revenue due to more uncompensated care, increased use of emergency rooms, and “adverse
selection” (as cost increases, participation by healthier individuals decreases, which increases the
average costs for those who continue their coverage).

Puts pressure on federal
leaders to approve the
waiver to change Medicaid

Drops 47,000 parents and 6,000 childless-adults from BadgerCare, if waiver not approved by
federal government.

The state budget requires DHS to obtain a “maintenance of effort” waiver from the federal
government by 12/31/11. If the waiver is not approved, the budget forces DHS to drop
BadgerCare coverage for 53,000 parents and childless-adults, making these Wisconsinites
uninsured. For example, parents in a family of three or four, both working minimum wage jobs
would be disqualified from BadgerCare.

3 Things You Can Do Today to Save BadgerCare!

1. Stay informed & Stay Connected!
a. Visit and sign up to join the coalition
b. Visit & connect with us on Facebook

2. Demand Opportunity for Public Input on Changes to BadgerCare
a. Call or email DHS Secretary Smith and ask that he schedule public hearings on
his proposed Medicaid Changes – (608) 266-1865 /
b. Call or email Chairs of the State Health Committees and ask that they schedule
hearings on the DHS proposed Medicaid changes – Senator Vukmir: (608) 266-
2512 / and Representative Jeff Stone: (608)
266-8590 /
c. Call your own state representatives and ask them to hold briefings in your
district – Legislative Hotline - 1-800-362-9472

3. Stand Up – Speak Out & Weigh In
a. Share why BadgerCare is important to you through the DHS online survey. Visit and click on the
“Provide Input” link on the left side of the page.
b. Participate in our Save BadgerCare Photo Petition. Simply email pictures
to of you holding signs that show why saving
BadgerCare is important to you.


Huge news! This morning at 6 o'clock, MoveOn members, union members, community organizers and thousands of others gathered in Zuccotti Park to stand in solidarity with the people who are occupying Wall Street and to defend them from eviction by Mayor Bloomberg.

They were supported by hundreds of thousands of people from around the country like you who signed petitions and flooded the city with calls.

And they won!

We've got video of the scene as the announcement was read and, well, you've got to watch it.

Thursday, October 13, 2011

What’s the Process for Implementing $554 Million of Medicaid Cuts?

Seven months ago, the Wisconsin Legislature hurriedly passed a bill giving the Department of Health Services (DHS) sweeping authority to rewrite the laws governing Medicaid and BadgerCare. On September 30, DHS finally unveiled a lengthy outline of its plans for cutting $554 million from the state’s Medicaid programs. Those plans include 39 initiatives, and you can find our preliminary summary of those plans and some of the likely consequences on the WCCF website.

The most frequent questions I get about the department’s proposals concern the procedural steps that lie ahead:  Do some of the proposals need to be reviewed by the legislature? If so, what will that timetable be?  Will there be any public hearings?  Do any of the changes require rulemaking?  What’s the role of the federal government in reviewing and approving the proposed changes?  Unfortunately, I can’t answer all of those questions, but I take a stab in this blog post at summarizing what we know at this point about the process for review and approval of the DHS plans.

The Legislature’s role – One thing that we know for sure is that the full Legislature does not need to review and approve any of the DHS proposals. That isn’t to say they couldn’t do so, or shouldn’t at least have meetings to hear the concerns of the people they were elected to represent, but the budget repair and budget bills give the decision making authority to unelected state officials. (See WCCF’s issue brief about the sweeping shift in power.)

The Joint Finance Committee’s role – The budget bill does provide one small check on the unprecedented delegation of policy-making authority to the executive branch. It gives the Joint Finance Committee (which is comprised of 12 Republicans and 4 Democrats) the option of reviewing any DHS proposals that conflict with current statutes. From the date when the Finance Committee formally receives the proposals (and that hasn’t happened yet), the committee has 14 days to request a meeting on proposals that conflict with the statutes. If the committee notifies DHS within that time period that it wants to hold a meeting to review those proposals, DHS may submit the proposals to federal officials only with the approval of the Committee. We don’t know yet whether the committee will hold a meeting.

Public hearings – It’s unclear if or when there will be any public hearings on the DHS proposals that make dramatic changes to BadgerCare or on the long list of proposed Medicaid-related changes. Secretary Smith told people at the Covering Kids and Families conference last week that there would be at least one hearing, though other DHS officials have reportedly made conflicting statements. The Save BadgerCare Coalition has requested DHS to hold hearings on the proposed BadgerCare and Medicaid changes, and has asked the Assembly and Senate health committees to do the same. DHS did hold a town hall meeting today on one particular proposal relating to long-term care (see Monday’s blog post).

The federal role – The vast majority of the proposals require federal approval, but for most of them the federal role is just to approve Medicaid “plan amendments.”  At the risk of over-generalizing, approval of such amendments is typically pretty routine, if the proposals don’t conflict with federal statutes or rules. However, proposals that do conflict with federal law require federal waivers of the conflicting statutes or rules, and getting waivers can be a lengthy process and is much more difficult than getting a plan amendment approved. Most of the changes relating to BadgerCare require a waiver of federal “maintenance of effort” (MOE) requirements, which are part of the federal health care reform law and which prevent the state from reducing coverage of adults below 133 percent of the federal poverty level. The MOE standards also preclude tightening of other standards that affect program participation (including such things as increasing premiums), or any reduction in child eligibility prior to 2019.

Reducing eligibility of adults – The budget bill says that if the DHS waiver request isn’t approved by federal officials by Dec. 31, 2011, then the department shall reduce eligibility of parents and childless adults to 133% of the poverty level (from 200% now), effective on July 1, 2012. That change would end BadgerCare coverage for an estimated 53,000 adults. The state’s self-imposed Dec. 31 deadline provides relatively little time for federal review of the waiver request, making it unlikely that it will be approved by the end of the year.  If the Legislature and Governor don't move the Dec. 31 deadline, it appears very likely that the state will end coverage for at least 53,000 adults next July.  (Unfortunately, we think the changes that would result if the state gets the waivers are even worse; we'll elaborate on that in a later post.)

We’ll provide updates as we learn more about the DHS timetable and whether the agency, the health committees or the Finance Committee plan to hold any hearings.

Medicaid Feedback Requested.... Again

Over the past year, while looking to reform the state’s Medicaid program, the Department of Health Services has taken several proactive steps to receive input from consumers, providers, and other stakeholders.  Last spring, the Department held statewide listening sessions to gather valuable input from the individuals that actually utilize and provide services.

The Department found that one of the most effective tools to organize and gather feedback was an online web portal that allowed individuals to voice their concerns directly to the Secretary’s Office.  Those comments helped shape the proposed Medicaid reforms that you see today. The Department has also posted these comments online:
If your constituents would like to voice their opinion directly to the Department on the recently released Medicaid Efficiencies proposals, please encourage them to use our online web portal.  Individuals can make general comments or they can comment on specific policies that have been proposed by the Department.  So far, hundreds of comments have been received as part of this discussion.

You can find a web link to our Medicaid Savings Initiatives website here:

For a direct link to the web portal, please click here:

If you have any questions, please feel free to call or email me anytime.

Thanks much,

Kyle O’Brien
Legislative Liaison
Office of the Secretary
Wisconsin Department of Health Services
All Save BadgerCare Coalition members and supporters are invited to attend this event at which DHS Secretary Dennis Smith and Medicaid Director Brett Davis are scheduled to attend.  Thanks to Community Advocates for offering this wonderful opportunity to hear from these DHS leaders.
Community Advocates Public Policy Institute "Conversations withPolicy Leaders": The Future of Health Care in Wisconsin
Monday, October 17th 4pm-6pm
Community Advocates Offices 728 North James Lovell St.Milwaukee
DHS Secretary Dennis Smith and Medicaid Director Brett Davis scheduled to speak
To RSVP, email Genynee at or call (4140) 270-2952