Seeking Legal Interns for Summer 2012

ABC for Health is seeking volunteer, work-study eligible, or students on public interest fellowships for this summer! The position requires admission to law school. Students will provide legal research and writing support for firm attorneys that may include client interviewing and follow-up, drafting letters and memos, assisting on court filings and briefs, and facilitating projects with other agencies and legislators. Other duties include interviewing clients at intake, client counseling, and investigation of health benefits denials. Legal research and writing experience are desired, as are proficiency in Microsoft Word for Windows and a background in health care. Ability to speak Spanish and/or Hmong is a plus. To apply, please email a cover letter and resume to Brynne McBride, Assistant Director.

Support Our Efforts!

2011 was a difficult year for many, including ABC for Health. Over $300,000 in funding and funding opportunities were eliminated from our budget. Consequently, our ability to serve Wisconsin families was greatly diminished. Please consider a tax-deductible donation to ABC for Health to keep advocacy, legal services, and projects like HealthWatch Wisconsin sustainable for years to come. Thank you!

Headlines
 

GAO Report on Health Care Reform’s Medical Loss Ratio Rules Indicates That Many Insurers May Satisfy Applicable Standards

 
The GAO report uses preliminary data submitted to the National Association of Insurance Commissioners (NAIC) on insurer experience in 2010—before the MLR requirements were applicable. Based on the 2010 data, the report concludes that most insurers would have met MLR standards had they applied in 2010. In particular, the data indicates that 77% of large group market insurers (and 70% in the small group market) would have met the standards. The report also notes that MLRs varied widely among insurers and that even MLRs for the same insurer varied widely from state to state

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HHS deems insurance rate hikes 'unreasonable' in 5 states
 The Hill, Jan. 12, 2012
Trustmark has raised its rates in Alabama, Arizona, Pennsylvania, Virginia and Wyoming by 13 percent, HHS said. In Alabama, the company has raised premiums by a total of 27 percent over the past year.

Study: Premiums could rise 25 percent without insurance mandate
The Hill, Jan. 12, 2012
Premiums would rise because young, healthy people would be less likely to buy insurance. The purpose of the mandate is, in large part, to force healthy people into the system, offsetting the cost of guaranteeing coverage to people with pre-existing conditions
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Medical Transport Lawsuit Gets Federal Injunction
California Healthline, Jan. 12, 2012
In addition to these four lawsuits over the 10% provider cuts, a federal judge also issued a preliminary injunction halting the 20% trigger cuts to In-Home Supportive Services. All of those lawsuits were filed before the governor released his current budget, which includes another series of health care reductions.
CLICK HERE to keep reading Articles and Opinions.

State & National News
 
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.