Budget Repair Bill Signed Into Law

Last week, Wisconsin legislators passed key non-fiscal portions of Gov. Walker’s budget repair bill, including provisions impacting Wisconsin's BadgerCare and Medicaid programs.  Gov. Walker signed the bill into law on Friday.

The new law shifts power over BadgerCare/Medicaid away from the elected legislature and hands the Department of Health Services (DHS) authority to make legal changes to BadgerCare/Medicaid eligibility and services with minimal public comment and legislative review. 

In the final version of the bill, the legislature appears to have changed the Medicaid provision to now require DHS to use the existing rulemaking process (not create a new rule-making process). This does not impact the otherwise unprecedented delegation of authority to DHS to supersede nearly all of the Medicaid statutes that have been carefully crafted over the last two decades.

Overall, the new law, effective March 26, could result in increased BadgerCare Plus premiums for the Core Plan, increased co-pays, and preclusion of many families who have access to employer coverage from participating in BadgerCare Plus.

Read the HealthWatch press release.
Read the Legislative Bureau Summary.

Related articles:
Low-income elderly could lose drug plan (Guy Boulton, Milwaukee Journal Sentinel, 13 Mar. 2011)
Birth control program takes hit in budget (Guy Boulton, Milwaukee Journal Sentinel, 12 Mar. 2011)
Farmers protesting against medical and dental care cuts (Ann Day, Milwaukee Examiner, 13 Mar. 2011)
Vital Signs: Medicaid programs also a casualty of last night's surprise vote, angry advocates say (Shawn Doherty, Capital Times, 10 Mar. 2011)
Local officials say Walker plan to privatize assistance programs will hurt poor families (Pat Schneider, Capital Times, 8 Mar. 2011)

HealthWatch News

Fourth Annual HealthWatch Conference is a Great Success!

Thank you HealthWatch members, faculty, and speakers, and all those who helped to make this year's conference so successful!

HealthWatch Wisconsin’s Fourth Annual Conference drew stakeholders from across the state to Madison’s Inn on the Park last Monday and Tuesday to learn about and discuss Wisconsin’s changing health care policies.  US Congresswoman Tammy Baldwin kicked off the conference on Monday morning, proclaiming that she's "never been more proud of Wisconsin" and sharing her insights on the state of health care in our state.  On Tuesday, Department of Health Services Secretary Dennis Smith offered a diverging view about health priorities in Wisconsin and fielded questions from HealthWatch members!

Here are a few comments from people who attended this year's conference:

"Thanks for the excellent conference - it was inspiring!"
"I would like to let you know this was the first HealthWatch conference I attended and thought it was WONDERFUL ... I certainly will try to make it an annual event."
"The conference was the best ever!"

HealthWatch award winners were honored at a lunch ceremony during the conference. Congratulations again to all of our award winners, and more importantly, thank you for all of your outstanding work!

Advocate of the Year: Pam Rabe, Managed Care Ombudsman
Elected Official of the Year: Rep. Sandy Pasch (D-Whitefish Bay)
Outstanding Media Coverage Award: Kurt Chandler, Milwaukee Magazine
Outstanding Outreach Efforts: Gwendolyn Altheimer, Program Manager City of Milwaukee Health Department Community Healthcare Access Program

The conference also received exceptional media coverage, including local TV stations, the Wisconsin Eye Network, the Wisconsin Health News, the Cap Times, and the Wisconsin State Journal. 

Powerful Public Hearings on BadgerCare/Medicaid

On each day of the Fourth Annual Conference, HealthWatch Wisconsin hosted a public hearing about proposed Medicaid and BadgerCare cuts in Gov. Walker’s budget bills.  Between 200 and 300 people attended the hearings over the two days, and many spoke of the impact BadgerCare and Medicaid programs have had in their lives.  Many attendees movingly explained how cuts to medical assistance threatened their survival. Consider the following public comments:

“I have a rare condition [that] requires surgery every two years or so … I need Medicaid to remain alive.”

“I became unemployed [when] I was three months pregnant, and my husband's work did not offer health insurance. I wasn't sure what I was going to do … BadgerCare was our saving grace.”

For more coverage of the public hearings, see the following:

Medicaid and BadgerCare debate continues (Julia Fello, WKOW, 8 Mar. 2011)
Medicaid changes provoke opposition (Gil Halsted, Wisconsin Public Radio, Superior Telegram, 8 Mar. 2011)
HealthWatch Wisconsin Forum/Hearing (Wisconsin Eye, 7 Mar. 2011)

Grapevine

Leaving Wisconsin?

Individuals enrolled in BadgerCare Plus may be familiar with some of the requirements for reporting changes. Specifically, an individual is responsible for contacting her Economic Support worker to update her case every time:

-The living arrangement changes;
-Someone moves in or out of the household;
-Someone in the house becomes pregnant or gives birth;
-The individual moves to a new address or state.

What isn’t as familiar is the penalty that may attach for failing to report these changes promptly. In particular, the BadgerCare Plus application now includes a notice informing individuals of the strict requirement to report changes in living situation within 10 days.  Individuals who move out of the state and don’t report this move within 10 days will be responsible to repay the BadgerCare Plus program for any payments they made to the individual’s HMO.

Why? BadgerCare pays a set amount every day to the HMOs that provide coverage for each person in the program.  Once you move out of state, you are no longer covered by BadgerCare.  The program aims to avoid unnecessary HMO payments for those who are no longer living in the state.  For this reason, you may be responsible to repay the BadgerCare Plus program for any payments they made to your HMO if you don’t report your absence. For example: if BadgerCare Plus paid your HMO $475 each month, you would have to repay BadgerCare Plus $475 for each month the HMO was paid EVEN IF you did not use your ForwardHealth card.

We have yet to see this enforced, but that doesn’t mean it hasn’t happened.  If you know anyone who’s been affected by this rule, let us know.

HealthWatch member Brenda Bonetti is a Patient Advocate at St. Croix Regional Medical Center. She and her co-workers are the first people that patients in need at the 24-bed hospital come into contact with after receiving medical care. Brenda helps uninsured patients by connecting them to state programs like BadgerCare Core and Basic, Family Planning and Well Woman. She provides patients with valuable information about these programs, helping them navigate through the complexities of coverage.

“[Patients] struggling through the process back and forth on their own without any information—getting it a piece at a time, on top of dealing with themselves or their family members being ill—makes the illness prolonged or worse if left untreated too long,” she said.

Brenda deals with a wide variety of tasks and patient-related issues on a daily basis, but she said the emotional nature of medical care is the hardest part. “Trying to explain to someone who is 80 years old why their insurance didn't pay properly for them, and they owe more money than they can afford…it’s heartbreaking,” she said.

In situations like these, Brenda sometimes helps patients call their insurance companies to look for a solution. Usually, she will offer self-pay patients a 20 percent hardship discount. Patients can also apply for additional discounts through the Community Care Committee, of which Brenda is a member.

She also coordinates the center’s chronic care program, which provides free services for patients with chronic conditions like diabetes and heart problems. She and her co-workers are developing a nationwide concept of their chronic care model to find new ways to care for these patients.

Brenda said that without attending an initial BadgerCare training session when she started her job 11 years ago, she would not have been able to help so many patients who never knew state programs were available to them, as well as educate her co-workers in how these programs work. She has also been a part of the Polk County HealthWatch Coalition since it started nine years ago.

Brenda was also at the HealthWatch Wisconsin Conference last week, and as a patient advocate, she is worried about the effects that Governor Walker’s budget repair bill will have on the people she helps. More than 6,600 people in Polk County are enrolled in BadgerCare, but a lot of her patients are currently on the waiting list. “They're waiting for something to happen in this state,” she said. “It isn't like they don't want to pay or wouldn't be willing to pay for it, they just need something to help them.”

Coalition Roundup

Click here for a list of upcoming coalition meetings.

Chippewa County HealthWatch met on Tuesday, March 8, and received an update from Lou Kelsey of the Eau Claire County HealthWatch Coalition on joint efforts by the two coalitions, including collaborative activities like the annual Epilepsy Stroll in the Park in May and the Epilepsy Camp schedule for July.  Vicky Seidlitz, Options Counselor for the Aging and Disability Resource Center, also spoke to the group about options for youth transitioning into adult services.  The next Chippewa County HealthWatch meeting is May 10, 2011.  For more information on Chippewa County HealthWatch, please contact Rose Marsh.

The Dane County HealthWatch's didn’t meet in March because of the HealthWatch Wisconsin Annual Conference.  Meetings will resume Monday, April 4, at the Waisman Community Outreach Center.  Dane County HealthWatch has invited Theresa Fosbinder of Planned Parenthood, as well as someone from the Wisconsin Well Woman Program, to discuss the possible effects of the budget and budget repair bills on their organizations and the services they provide.  Dane County HealthWatch will also be examining the Medicaid Audit as an opportunity to address some of the issues seen with the Enrollment Services Center and other aspects of reporting for Medicaid recipients in Dane County.  The group also needs to find an alternate location for its May 2 meeting.  For more information about the Dane County's Coalition, please contact Adam VanSpankeren.

The Dunn County HealthWatch Coalition’s February meeting was canceled due to severe weather, but the original agenda items will be covered at the next meeting, which is scheduled for Thursday April 7. Chris Kruse, an EMT and Chief Medical Examiner for Dunn County will be coming to speak to the group about causes of death in Dunn County. For more information, please contact Wendy MacDougall or Sandy Nevin.

Eau Claire HealthWatch met Thursday, March 3, at Luther Hospital.  Ann Z. Schell, the Transportation Planner at the West Central Wisconsin Regional Planning Commission (WCWRPC), came to speak to the group about the provisions of the budget and budget repair bills which will cause major changes in the function of the WCWRPC.  Transportation continues to be a major barrier to accessing health care in Eau Claire County – particularly in the rural areas.  Unfortunately, Ann did not have any positive news to share with the group, but she has promised to keep Eau Claire County HealthWatch informed as more changes become known.  For more information on Eau Claire County HealthWatch, please contact Pat Perkins.

The Milwaukee HealthWatch Coalition met last Wednesday to welcome Katherine Quinn of the Milwaukee Health Department. She gave a presentation on Project LAUNCH, which is a grant program of the federal Substance Abuse and Mental Health Services Administration (SAMHSA) that seeks to promote the wellness of young children birth to age eight. The group also discussed BC+ Emergency Services, BC+ Prenatal Program, and applications for Elderly, Blind, and Disabled Medicaid. For more information about the Milwaukee HealthWatch Coalition, please contact Nora Foshager.

The Pierce County HealthWatch Coalition had a steering committee call on March 10th to begin planning their kickoff meeting.  It currently looks like the meeting will happen late April or early May.  No speaker has been formally announced, but the group talked about the possibility of enlisting Mike Rust of ABC for Rural Health to engage folks about the development of the coalition, access to care and coverage issues, Medicaid programs and reimbursement, and the possibility of federal match.  For more information about the Pierce County HealthWatch Coalition, please contact Lisa Raethke.

The Tri-County HealthWatch Coalition is having a strategic planning meeting on Tuesday, March 29, to follow up on the very constructive brainstorming session of February 22.  Thank you to Susan Garcia Franz, Tri-County HealthWatch’s coalition chair, for speaking at the HWW Annual Conference about the status and development of their coalition. Contact Susan Garcia Franz for more information on Tri-County HealthWatch.

CKSN Corner

Covering Kids with Special Needs

March 29-30. Ninth Annual Academic Symposium, 21st Century Healthcare: Facts, Myths, Implications and Ethics. Marian University, Fond du Lac. Free and open to the public. For a complete list of days activities visit marianuniversity.edu/academicsymposium.

April 12-13. 4th Biennial Wisconsin Health Literacy Summit. Health Literacy Wisconsin, a division of Wisconsin Literacy, Inc.  For more information click here.

April 28-29. Circles of Life 2011. Hyatt Regency, Milwaukee. State's largest conference for families of children with disabilities and special health care needs. For more information, click here.

State & National News

Analysis and Comment

"A La Carte" Health Insurance

Republican legislators Sen. Vukmir (R-Wauwatosa) and Rep. Nygren (R-Marinette) have authored two bills that would allow insurers to offer policies that are exempt from state mandates requiring policies to cover a range of conditions and procedures, including autism and mammography.

The first bill allows insurance companies to sell "a la carte insurance policies" without state mandates. Consumers would get a list with their applications showing the premium cost each service would add to their policy. The second bill would allow out-of-state health insurers to offer plans in Wisconsin that do not conform to Wisconsin mandates.  Plans need only to comply with “home-state” mandates. Wisconsin's Commissioner of Insurance can waive state mandates so Wisconsin insurers can offer similar policies.

The proposed legislation would undo the hard-fought consumer protections written into our laws to protect our most vulnerable populations, including autism coverage, maternity, diabetes, cochlear implants, and more. Allowing the Commissioner of Insurance to waive or eliminate these basic protections will prove to either eliminate or drive up the costs of private insurance coverage for families with disabilities, special needs, or unique medical situations. This fosters an approach of creating silos of health coverage, isolating the healthy and wealthy from the elderly and those with disabilities. It will stop a trend of increasing the risk-sharing in large scale pooling that brings down cost for everyone. This, at a time when the safety net programs of Medicaid and BadgerCare are threatened by the Secretary of Health Services.  The Acts are detrimental to the essential care and coverage needed by our constituents, especially the most vulnerable across the age and disability spectrum.

Related articles:
Vital Signs: GOP bills to allow 'a la carte' health insurance policies to ignore state mandates (Shawn Doherty, Capital Times, 7 Mar. 2011)

Headlines

Health Reform Quiz
Kaiser Family Foundation
"Take [a] short, 10-question quiz to test your knowledge of the law, and then find out how you compare to the rest of the country, as represented by the findings of the Kaiser Family Foundation's monthly Health Tracking Poll."
.
UWM Public Health School Advances
The Milwaukee Business Journal, 15 Mar. 2011
“Gov. Scott Walker’s proposed state capital budget, released Monday, recommends $12.25 million for the university to buy the former brewery building for the school, which is scheduled to open in fall of 2012."

The Basic Health Program Option under Federal Health Reform: Issues for Consumers and States
Stan Dorn, Prepared for State Coverage Initiatives by the Urban Institute, Mar. 2011
“Using the Basic Health Program to build on the existing infrastructure of Medicaid and CHIP is an option that deserves serious consideration.”

Why farmers are driving their tractors to protest at the Capitol
Jessica VanEgeren, Capital Times, 12 Mar. 2011
“'These are people who are starting to realize Walker's agenda is sacrificing Wisconsin's quality of life for everyone, not just labor unions,' Peck says. 'That's why they are rallying in Madison.'"

Obama Administration Seeks Fast Appeal of Health-Care Ruling
Andrew Harris, Bloomberg Businessweek, 9 Mar. 2011
“The U.S. Justice Department is seeking an expedited appeal of a federal judge’s ruling striking down President Barack Obama’s health-care reform legislation.”

Walker's elimination of family planning funds could jeopardize federal dollars, close clinics
Judith Davidoff, Capital Times, 8 Mar. 2011
“Gov. Scott Walker's budget proposal to eliminate all state funding for family planning services for low-income residents could also jeopardize federal dollars for pregnancy prevention.”

Diversity and disparities in health and health care
Press Release, Wisconsin Medical Society, Mar. 2011
“Two studies in the current issue of WMJ (Vol. 110, No. 1) examine diversity issues in health care. Maternity care and cancer prevention are addressed.”

Editorial: Experimentation, yes, but done transparently
Milwaukee Journal Sentinel, 5 Mar. 2011
“Wisconsin's medical assistance programs for the needy have grown dramatically in recent years as the economy soured, and the bill is due: The state faces a $1.8 billion budget hole in those programs - half of the deficit Gov. Scott Walker seeks to fill with his new two-year budget proposal.”

Vital Signs: Where's the beef? Advocates for people on Medicaid pan budget speech
Shawn Doherty, Capital Times, 2 Mar. 2011
“Advocates for the 1.2 million Wisconsin residents enrolled in Medicaid programs say they got exactly what they thought they'd get from Gov. Scott Walker's budget speech Tuesday: not much."