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Your Source for Strategies, Suggestions, and Stories on Accessing Health Care and Coverage in Wisconsin
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Top Story
Consumer Assistance in Wisconsin: Closed for Business
Wisconsin’s Office of the Commissioner of Insurance announced last week that it would terminate a new consumer assistance program for Wisconsin
families enrolling in health care coverage. The OCI is cutting the program because it is "a waste of taxpayer money," according to Deputy Commissioner Dan
Schwartzer, a former insurance industry insider and lobbyist.
The OCI’s action will leave many health care consumers in the lurch. Bobby Peterson, public interest attorney at ABC for Health, Inc.,
said the end of the consumer assistance program "means virtually no assistance for over half our insured population in self-funded
ERISA health plans and much more limited assistance for individuals recently laid off from work, families facing bureaucratic hurdles with the
BadgerCare programs or other health coverage programs, and families facing an illness simply trying to understand and coordinate public and
private coverage eligibility concerns."
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Vol. 7, No. 3
February 15, 2011
In this issue:
Top Story
Grapevine
HealthWatch News
HWW Member Profile
CKSN Corner
State & National News
On our website:
Conference Information
HealthWatch Membership
Upcoming Coalition Meetings
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Former Insurance Commissioner Sean Dilweg started the consumer assistance program with a $600,000 grant from the U.S. Department of Health and Human Services. As part of the program, the OCI selected ABC for Health to provide consumer assistance related to enrollment, benefits troubleshooting, and health care service provider education about health coverage benefits and programs. Since beginning its contract with the OCI in December 2010, ABC for Health has helped over 60 Wisconsin families navigate complicated public and private benefits and eligibility issues.
Said Peterson, "It seems obvious that the new Commissioner, Ted Nickel, and his insurance industry pals are only interested in keeping health consumers confused about health care coverage issues. By sending scarce federal money back to Washington, Nickel demonstrates he could care less about promoting jobs in Wisconsin."
To learn more, read ABC for Health’s press release and go to the HWW website.
Related articles:
New state insurance commissioner terminates $637K federal health care grant, David Wahlberg, Wisconsin State Journal, 10 Feb. 2011
Insurance commissioner cancels consumer program, returns federal funds, Guy Boulton, Milwaukee Journal Sentinel, 10 Feb. 2011
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Grapevine
Have you heard of "MedSolutions"?
The State of Wisconsin has contracted with MedSolutions, a health utilization management company, to receive, review, and determine all prior authorization requests for advanced radiological services.
This means that, as of December 6, 2010, all fee-for-service members enrolled in Medicaid—including BC+ Standard and Benchmark Plans, Core Plan, Basic Plan, and Express Enrollment for children and pregnant women—must have a prior authorization approved by MedSolutions before having a CT/CTA, MRI/MRA, or PET scan.
A prior authorization is not necessary for scans conducted during an emergency room visit, in-patient stay, or 24 hour observation.
There are three ways to request prior authorization through MedSolutions:
- Internet: www.medsolutionsonline.com
- Phone: 888-693-3211, 8 a.m. to 9 p.m. (EST), Monday through Friday
- Fax: 888-693-3210. Fax forms are available at www.medsolutionsonline.com or by calling the MedSolutions Customer Service at 888-693-3211.
Please note, for URGENT or Stat-PA cases, use the phone option only.
Stay tuned to the HealthWatch Wisconsin Update for a refresher on how to get a prior authorization.
HealthWatch News
Annual Conference
A detailed schedule for the Fourth Annual HealthWatch Conference is available on the HealthWatch website.
Conference speakers include:
Coalition Roundup
Click here for a list of upcoming coalition meetings.
Dane County HealthWatch met Monday, February 7, when Bobby Peterson, Executive Director of ABC for Health, came and spoke to the Coalition about the upcoming HealthWatch Wisconsin Annual Conference, the new administration and potential changes to health care reform, the Medicaid audit, and the independent review process. The group also discussed the possibility of a future asset mapping session to allow coalition members to better coordinate with one another. Dane County HealthWatch’s March meeting is canceled because it falls during the HealthWatch Wisconsin Annual Conference. For more information about the Dane County's Coalition, please contact Adam
VanSpankeren.
The Milwaukee HealthWatch Coalition met last Wednesday to welcome
Kevin O’Brien of Milwaukee Mental Health Consultants (MMHC), who gave a presentation about the MMHC's services
and fielded questions from the group. The group also had a lengthy discussion about several
access-to-care-and-coverage issues that coalition members have been seeing among member and client populations in Milwaukee County.
For more information about the Milwaukee HealthWatch Coalition, please contact Nora Foshager.
The growth of the Pierce County HealthWatch Coalition is moving along, as Mike Rust of Polk County HealthWatch met with Lisa Raethke and other coalition partners to help with coalition building, as well as access to care and coverage issues. The Pierce County HealthWatch kick-off meeting will be scheduled in the near future! If you are interested in the Pierce County HealthWatch Coalition, please contact Lisa Raethke.
Development for the Tri County HealthWatch Coalition is going well. They have a Community Input Meeting on Tuesday, February 22, to get feedback from community stakeholders regarding the direction of the coalition and upcoming projects. Almost thirty people have RSVP‘d! Susan Garcia Franz has also reported that two Federally Qualified Health Centers have expanded their dental coverage for MA clients in the Tri County region: Fox Cities Community Health Center and the Tri County Community Dental Clinic. If you are interested in attending the meeting or want more information on the Tri County HealthWatch Coalition, please contact, Susan Garcia Franz.
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Member Profile
Joshua Salazar
by Adam VanSpankeren
Starting in February, the HealthWatch Wisconsin staff will begin profiling members and member organizations in the Update! We hope that this will not only introduce members to each other but shine a spotlight on some of the shared challenges that we all face and increase member communication about those challenges.
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First up is Josh Salazar, Government Programs Counselor at UW Hospital in Madison and one of the chairs of the Dane County HealthWatch Coalition. As a Government Programs Counselor, it’s Josh’s job to meet with and assist patients at UW Hospital who might be eligible for BadgerCare and other medical assistance programs.
Josh says that some of the biggest challenges of his job involve working with people who are very sick, especially those who fall into the gray area between programs. Childless adults, for example, who don’t qualify for BadgerCare or Disability programs, can often be difficult to assist.
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But childless adults are not the only group that can be hard to assist. Many families that Josh works with do not fall into easy to define categories. "In some situations, you have grandparents taking care of grandkids, aunts and uncles taking care of nieces and nephews—it’s not always easy to define the caretaker relationships and find which programs patients might qualify for."
Josh has been a member of HealthWatch Wisconsin and a part of the Dane County HealthWatch Coalition since 2000. In that time, Josh says that he has always found HealthWatch to be a valuable resource. "It’s good to keep up with HealthWatch because things change—and are constantly changing. Going to the meetings, meeting new people, reading the newsletter—they help keep your hand on the pulse, to hear about things as they happen and sometimes before they happen. So you aren’t caught off guard when a rule or program changes."
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CKSN Corner
February 16-18. Eighth Annual Wisconsin Transition Conference. Kalahari Resort, Wisconsin Dells.
The conference is for all people working with and supporting youth with disabilities as they transition
from high school to adult life. Early bird registration (through Dec. 23) is $250 for the general
conference (Feb. 17-18) or $75 for the preconference on Feb. 16; after Dec. 23, registration is $300 for
the general conference and $100 for the preconference. For more information, click here.
Feb. 22, 2011, 12:00 - 1:00 pm. FACETS Free Telephone Workshop, Section 504 & ADA. PRESENTER: CHARLOTTE PRICE. This workshop contains basic information on Section 504 of the Rehabilitation Act of 1973. Participants will learn:
- What is Section 504 and how do students with disabilities qualify
- A school’s obligations under Section 504
- Services available under Section 504
- How Section 504 compares with IDEA
- How Section 504 may help with life after high school (college/work)
TO REGISTER: Contact Sandra McFarland at WI FACETS - (877) 374-0511 or smcfarland@wifacets.org or register on line on our newly redesigned website: www.wifacets.org.
Sandra will mail/email to you all workshop materials and provide you with the toll-free number to call in for the workshop.
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.
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State & National News
Analysis & Comment
Walker Releases Budget Repair Bill
Gov. Walker released the details of his budget repair bill last Friday. While the bill does not propose specific changes to the state's Medical Assistance programs, it authorizes
the Department of Health Services to make program changes, including new approaches to program benefits, eligibility determination, and provider
cost-effectiveness. In particular, the bill allows modifications that reduce income levels for determining eligibility and restrict benefits to non-US citizens.
Walker’s delegation of authority to the DHS may be illegal, says Bobby Peterson, public interest attorney at ABC for Health. "First, these are questions of policy that don’t belong in a budget bill. And beyond that, the DHS is an administrative agency; it should not be granted power that rightfully belongs to the legislature."
Click here to read the Governor's press release.
Click here to read the bill.
Click here to read ABC for Health's Action Alert.
Related articles:
Bill would give Walker sweeping powers over health programs, Jason Stein, Milwaukee Journal Sentinel, 14 Feb. 2011
Budget repair bill gives Walker free hand to revamp Medicaid programs, Shawn Doherty, Capital Times, 14 Feb. 2011
Medicaid Power Shift Stifles Debate and Does Not Belong in Budget Repair Bill, press release, Wisconsin Council on Children & Families, 14 Feb. 2011
Cuts to BadgerCare could leave 1,000 local adults uninsured, Adam Rodewald, Northwestern, 13 Feb. 2011
CHIPRA Turns Two
Feb. 4 marked the
second anniversary of the Children’s Health Insurance Program Reauthorization Act (CHIPRA).
Thanks to CHIPRA, an increasing number of children in Wisconsin and across the country have gained access
to health care. In 2010, Medicaid and CHIPRA enrollment increased by two million, for a total of
42 million children enrolled in the program. In 46 states and Washington, D. C., the program covers
children from families with incomes up to 200% of the federal poverty level (FPL). (Wisconsin limits eligibility
at 300% FPL.) Fifteen states, including Wisconsin, won performance bonuses for enrolling 875,000 children above
the baseline enrollment. Wisconsin qualified for a 2010 bonus of $23,076,127. [Editor's note: We have heard no information about how Wisconsin will use the award money, besides restricting eligibility.] CHIPRA’s
annual report also highlighted Wisconsin’s simplification of ACCESS, allowing families to renew
coverage and update information online, and collecting information from available databases that contain
information concerning enrollment eligibility.
Headlines
Deficit reduction – Step 1: making health care affordable
Ron Kind, press release, 11 Feb. 2011
U.S. Rep. Ron Kind proposes to reduce Wisconsin’s budget deficit by changing Medicare provider payments to reward quality rather than quantity. Changing the Medicare payment system, he says, will add to the cost savings introduced by the federal health care reform law.
See also: Kind tackles health care law myths, Terry Rindfleisch, LaCrosse Tribune, 4 Feb. 2011
Former Health Services secretary picked to head health care costs reform program
David Wahlberg, Wisconsin State Journal, 7 Feb. 2011
Karen Timberlake, former secretary of the Wisconsin Department of Health Services, will head a new payment reform initiative aimed at rewarding doctors for the quality, rather than the quantity, of the care they provide. The new initiative is a project of the Wisconsin Health Information Organization.
Wisconsin proceeding with health care law
Scott Bauer, Associated Press, 4 Feb. 2011
Although Attorney General Van Hollen pronounced the health care law dead, Wisconsin is proceeding to implement the law.
Feds outline ways to reduce Medicaid costs
Guy Boulton, Milwaukee Journal Sentinel, 3 Feb. 2011
Secretary of health and human services Kathleen Sebelius told state governors Feb. 3 how they can save money on Medicaid by reducing benefits instead of changing eligibility rules.
Related articles:
Governors Get Advice for Saving on Medicaid, Robert Pear, New York Times, 3 Feb. 2011
How the Affordable Care Act empowers states, Kathleen Sebelius, Washington Post, 10 Feb. 2011
Senate rejects repeal of health-care law as fight shifts to courts
David A. Fahrenthold and N.C. Aizenman, Washington Post, 3 Feb. 2011
While Republicans in Congress lost the fight to repeal the health care law, the courts have taken up the battle. Two judges have found provisions of the law unconstitutional, and the cases will likely end up in the Supreme Court. Many other court cases against the law are in progress.
Related articles:
On health care, justice will prevail, Laurence H. Tribe, New York Times, 7 Feb. 2011
A new Dem threat to health care law, Manu Raju, Politico.com, 7 Feb. 2011
Dead or alive?, Economist, 3 Feb. 2011
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