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HealthWatch Analysis and Comment
Long-Awaited Medicaid Audit is Released

The Joint Legislative Audit Committee, led by Republican lawmakers, requested that the Legislative Audit Bureau (LAB) conduct a comprehensive audit of Wisconsin’s Medical Assistance programs back in January 2011. Now, almost a year later, the LAB on December 20, 2011 released its comprehensive audit report. The full audit reveals a disproportionate, wasteful dependence on vendors to administer Wisconsin’s Medicaid programs and no evidence of the fraud and abuse that Medicaid opponents cited back when they called for the audit. While the audit report is not as thorough as some we have seen in the past, it still offers valuable insights into the status of Wisconsin’s health care system and spending – insights that could have been used to inform DHS officials and lawmakers before they developed and approved a waiver proposal that may irrevocably alter the face of Wisconsin’s public health landscape. Watch for a future edition of the HealthWatch Reporter devoted entirely to the Medicaid Audit.

• Audit: Red flags are flying in Wisconsin's Medicaid program
• Audit of Wis. Medicaid program raises concerns
• State audit of medical assistance programs does not find evidence of widespread fraud
• Audit debunks widespread myth of fraud in Medicaid [Press Release]
• Medicaid contractor spending increases

Haven't Contacted the Feds Yet about Wisconsin's Proposed Medicaid Cuts?

There's still time!

CMS does not have an "official" public comment process for the Wisconsin MOE waiver request, the proposal to drastically change eligibility for BadgerCare and Medicaid programs in Wisconsin. Instead, you can contact the US Department of Health and Human Services (HHS) directly to comment on the Wisconsin DHS Waiver Request. Please send an email or call the Regional Director for our area, Kenneth Munson:

 

Kenneth Munson,Regional Director

Region V of the Department of Health and Human Service

Call: 312-353-5160

Email: Kenneth.Munson@hhs.gov

Mr. Munson will see that ALL comments on the waiver request (pro and con) are directed to appropriate CMS officials.

Tell your BadgerCare or Medicaid Story! Why is BadgerCare or Medicaid important to you and your family? What would happen if BadgerCare or Medicaid ended? CLICK HERE to complete a story form!

SPEAK UP: Comments Wanted by Feds
 
Insurance Commissioner Nickel Opposes Possible $13 Million Consumer Rebates

At the end of October, Wisconsin's Commissioner of Insurance Ted Nickel sent a letter to the Department of Health and Human Services, seeking an exemption from the federal law that requires health insurers to spend at least 80 cents of every dollar collected in customers' premiums on medical care. Commissioner Nickel said in his letter that he would rather see a gradual "phasing in" of the medical loss ratio requirement. Under the health reform law establishing this "medical loss ratio," the rule is that insurers who fail to meet the 80% minimum would have to provide rebates to their customers. Commissioner Nickel said he would prefer the money, estimated to be about $14 million in rebates to Wisconsin consumers under the law, was instead retained by the insurance companies.HealthWatch Wisconsin covered the story here.  

On January 9, 2012, the feds sent a letter back to Commissioner Nickel. The Department of Health and Human Services Center for Consumer Information and Insurance Oversight (HHS) had several questions for Nickel, asking him to provide support on the numerous claims he made in his request. They asked Nickel in more than one instance to explain his math as the feds could not derive the same numbers as Nickel. They asked him to provide withdrawal notices of the companies Nickel said were leaving the Wisconsin marketplace. In what will most likely be construed as a mighty blow, they very kindly thanked Nickel for “Wisconsin’s cooperation in working together to implement the Affordable Care Act.” In fact, Wisconsin is delinquent in implementing health reform, thanks most recently to an emergency rule promulgated by Commissioner Nickel that prevents federally required changes to independent review.
CLICK HERE to keep reading and learn how to comment to the feds on Wisconsin's MLR Waiver.

Medicaid Budget Numbers Change
 

Governor Walker and Department of Health Services Secretary Dennis Smith announced new adjustments to the Medicaid budget numbers, protecting 53,000 Wisconsin adults from termination of vital health coverage available through the BadgerCare program. Originally, in March 2011, Wisconsin’s Administration introduced a budget repair and subsequent biennial budget that included a provision to terminate 53,000 childless adults and parents from BadgerCare Plus should the federal review of the MOE waiver request not be completed by December 31, 2011. In a related letter dated December 30, 2011, Smith informed the Joint Finance Committee that new budget numbers indicate that he overstated his initial projection of $554.4 million in savings required to balance the Medicaid budget. Projected budget deficits now total less that $232 million dollars, a drop of over $300 million.

Please Add Your Name to New Save BadgerCare Petition!  Tell Walker & Smith to Protect Health Care Access for Wisconsin Working Families!

www.savebadgercare.org

January 10, 2012

Send a message to Wisconsin leaders today - Protect & Save BadgerCare!   Wisconsin's Medicaid deficit is now expected to be $322 million less than was anticipated a few months ago, and the state has just received a $24 million federal bonus for BadgerCare's success.  Those developments enable the state to protect BadgerCare, while also lifting the cap on the Family Care program.  Please join us in fighting to preserve BadgerCare and to oppose changes that would adversely affect children, people with disabilities, and adults, and would result in thousands of families becoming uninsured. Add your name to our new Save BadgerCare Coalition petition being sent to Governor Walker, DHS Secretary Smith and Joint Finance Committee Co-Chairs - Senator Darling and Representative Vos. http://www.change.org/petitions/save-badgercare-2 Thank you!    Thank you for supporting BadgerCare and Medicaid.  Be sure to forward this email to others letting them know that MEDICAID MATTERS!  For more information and to join the Save BadgerCare Coalition, visit: www.savebadgercare.org.

Ms. Marilyn Tavenner
Acting Administrator
Centers for Medicare & Medicaid Services
Hubert H. Humphrey Building
200 Independence Avenue, SW, Room 3 
Washington, DC 2020]

Dear Administrator Tavenner:

As representatives of the state of Wisconsin, we are proud of our strong Medicaid and Childrens
Health Insurance Programs, known to Wisconsinites as BadgerCare. BadgerCare provides
efficient, affordable coverage to almost 800,000 people in our state and leads the nation in access
to great quality health care. As you know, our state has requested to make changes to the
program that would dramatically change the structure and eligibility requirements. We are
concerned about these changes and urge you to carefully consider the effects of such provisions
on families in our state.

On November 10, 2011, the Walker Administration submitted a waiver to CMS that, if approved,
would result in loss of coverage for an estimated 64,000 Wisconsinites including almost 29,000
children. The Walker Administration asked that this waiver be approved by December 31, 2011
or 53,000 low-income adults would be dropped from the rolls.

As you know, CMS responded to the state on December 9, 201 it made a final decision on the
waiver application that it will not be issued by the end of this year and we support this conclusion. We
urge CMS to carefully review the proposed waiver and remain firm on granting waivers of the
maintenance of effort (MOE) in the Affordable Care Act. CMS has refused so far to grant
waivers of the MOE requirement, because such waivers would erode coverage for low-income
children and adults. We do not believe that the Wisconsin Waiver proposal presents any
justification to change course. It is important that CMS carefully deliberate such changes with
the state so that low income families do not lose health coverage.

Despite the December 31 deadline the state has set, there is still time to formulate other options
that would not require cutting off coverage for adults with incomes above 133 percent of the
poverty line in July 2012. For example, according to the Legislative Fiscal Bureau, Wisconsin
expects to receive a performance bonus based on increased enrollment of children in Medicaid
and CHIP in an amount similar to what the state received last year, which was $23.1 million.
This funding would help resolve budget issues the state faces while still maintaining coverage.

We have worked hard in the past to ensure that our state receives adequate funding and
flexibility to maintain and improve access to BadgerCare; We will continue to do so.

We respectfully ask that you give your immediate attention to this matter and that CMS continue
its close review of the proposal with the goal of maintaining coverage for low-income families. If
you have any questions, please do not hesitate to call upon our staff to assist you.

Sincerely,

Senator Herb Kohl

Congresswoman Tammy Baldwin

Congressman Ron Kind

Congresswoman Gwen Moore

Rep. Pasch Statement on Audit of State Health Programs

 

 

MADISON – State Representative Sandy Pasch (D – Whitefish Bay ) released the following statement regarding the release of a Legislative Audit Bureau (LAB) evaluation of our state’s vital Medical Assistance programs:

 

“It is clear that we must critically examine options to make our state's Medical Assistance programs more efficient and cost-effective. The LAB audit provides a deliberative analysis and thoughtful range of potential changes to address financial pressures on these important programs. 

 

“Unfortunately, instead of considering these weighty decisions in an inclusive, accountable and evidence-based manner that allowed for ample public input and legislative oversight, the Walker administration rushed through a misguided and ideologically-driven plan that will punish tens of thousands of the neediest and youngest Wisconsinites. 

 

“Especially in light of LAB’s findings – as well as the federal government’s announcement that they likely will not be able to meet the Walker administration’s self-imposed deadline to consider their far-reaching proposal – we urge his administration to slow down and work with federal and state officials in order to achieve savings in our important Medicaid and BadgerCare programs without seriously risking the health of our most vulnerable for years to come.”