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Your Source for Strategies, Suggestions, and Stories on Accessing Health Care and Coverage in Wisconsin
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Breaking News: Gov. Walker Unveils State Budget
Medicaid Reductions Total $500 Million
As the budget repair bill protests entered their third week at the state capitol, Gov. Walker convened a joint session of the legislature to unveil Wisconsin's biennial state budget. Read our full article below in "State & National News."
HealthWatch News
Annual Conference: There's Still Time to Register!
HealthWatch is pleased to welcome conference speakers from the WI Department of Health Services, including: Secretary Dennis Smith and Access & Accountability Administrator Brett Davis!
Join us for an exciting conference in Madison, the epicenter of political discourse on the future of health coverage programs in Wisconsin! We are pleased to welcome additional special guest speakers: Congresswoman Tammy Baldwin, The Progressive's Amitabh Pal, the Milwaukee Journal Sentinel's Ricardo Pimentel, and Chair of the Senate Committee on Public Health, Senator Pam Galloway (R-Wausau). Joining via video/teleconference link are Democratic Senators Jon Erpenbach (D-Waunakee), Kathleen Vinehout (D-Alma) and others!
Public Hearing:
HealthWatch will also conduct a Public Hearing and hear testimony from the people of Wisconsin on the importance of BadgerCare and Medicaid programs. Individuals, families, and care providers are welcome to join us to share their stories! The Public Hearings will run March 7 and 8 from 2-4pm each day. The Hearings will conclude promptly at 4pm in time for a rally and march around the capitol to raise attention to the vital needs of BadgerCare and Medicaid recipients. Read more on how you can join us here.
Additional Conference Information:
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To register online, Click Here or call to register over the phone: (608)261-6939 ext. 204.
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"Featured Conference Workshops" and additional information is available Here.
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View the Full Conference Agenda Online.
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Attorneys and Social Workers: over 8.5 CEUs available for this conference.
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Vol. 7, No. 3
March 2, 2011
In this issue:
HealthWatch News
Case Tip
HWW Member Profile
CKSN Corner
Ops Memos
State & National News
On our website:
Conference Information
HealthWatch Membership
Upcoming Coalition Meetings
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HealthWatch Debuts this Year's Award Winners
Congratulations to our winners! Please join HealthWatch in honoring our 2010 Award winners:
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Advocate of the Year: Pam Rabe, Managed Care Ombudsman
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Elected Official of the Year: Rep. Sandy Pasch (D-Whitefish Bay)
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Outstanding Media Coverage Award: Kurt Chandler, Milwaukee Magazine
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Outstanding Outreach Efforts: Gwendolyn Altheimer, Program Manager City of Milwaukee Health Department Community Healthcare Access Program
The ceremony to celebrate these individuals for their outstanding work in the field of public health will coincide with the Fourth Annual HealthWatch Wisconsin Conference. Join us Tuesday, March 8, 2011, from 12:15pm-1:00pm at the Best Western Inn on the Park, Hall of Wisconsin Ballroom.
We'll celebrate with our winners during a special awards lunch. If you plan to attend the entire conference, please click here to register. If you intend to come just for the awards reception, please RSVP to Adam at ABC for Health (608-261-6939 ext. 204).
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Walker Administration Terminates Health Care Consumer Assistance Program: CLOSED FOR BUSINESS as of March 12
Wisconsin secured a federal grant worth more than $637,000 in late 2010 to fund a Consumer Assistance Program for Wisconsin’s health care consumers. Governor Walker’s administration terminated the program and is sending the unused money back to Washington. Walker’s new Insurance Commissioner and former insurance industry lobbyist, Ted Nickel, says the Consumer Assistance Program will end on March 12.
The goal of the Consumer Assistance Program was to "educate consumers about their health coverage options, empower consumers, and ensure access to accurate information." Commissioner Nickel called this effort a "waste of taxpayer money." Now many Wisconsin taxpayers—consumers trying to find affordable health coverage, appeal a coverage denial, or navigate the complex world public and private benefits—are left out in the cold. For more information visit: http://www.safetyweb.org/projectsConsumerAssistance.html |
Case Tip
Advocacy Tips for Faster Prior Authorizations
Medicaid, including BadgerCare, requires a prior authorization (PA) for certain medical services, treatments, equipment, and medications. For some individuals, these services may be extremely urgent; waiting for the provider to mail a PA and then waiting to receive the sate’s decision on the PA may not be an option. What happens when you need services immediately and do not have time to wait for the processing of a regular PA? Consider the following steps for streamlining the PA process:
1. The STAT-PA: The Wisconsin Specialized Transmission Approval Technology-PA (STAT-PA) system is an electronic PA system that allows Medicaid-certified providers to receive PAs electronically rather than by mail or fax. Providers answer a series of questions and learn immediately if the PA is approved or returned. Providers communicate with the Wisconsin STAT-PA system by entering requested information on a touch-tone telephone keypad or by calling the STAT-PA help desk. Providers must have their eight-digit Medicaid provider number to access the Wisconsin STAT-PA system. The Wisconsin STAT-PA system is available by calling one of the following telephone numbers:
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Touch-Tone Telephone |
Help Desk |
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(800) 947-1197 |
(800) 947-1197 and press "0" |
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(608) 221-2096 |
(608) 221-2096 and press "0" |
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Available from 8:00 a.m. to 11:45 p.m., seven days a week. |
Available from 8:00 a.m. to 6:00 p.m. Monday through Friday, excluding holidays. |
2. The Complete PA: In non-emergency situations you can streamline PA processing by providing as much information as possible up front. PAs can take months to process, and families often receive denials simply because the information they provided was incomplete or not specific to the medical procedure being requested. To avoid these delays, collect letters from the treating physicians, make photocopies of relevant parts of the medical records, include your caretaker journals, and ask for a copy of your therapist’s notes to help add context to the request the provider submits. A PA request that simply repeats an Individualized Education Plan or a prior request for service has a high likelihood of failing if it appears redundant or duplicative.
3. The Second Try: If a PA has been denied in the past, make sure the provider specifies why this new request is different. Highlight changes in the medical condition that have occurred between the submission of the PAs, explain the need for this PA differently than you explained it in the prior request, and be sure to document your statements with copies of the medical record or letters from the doctor. A lot can change in six months or a year. Documenting those changes or medical needs as they occur can help get you ready for that next PA.
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Member Profile
Susan Garcia-Franz
by Katie Foran-McHale
In this edition of the Update we feature Susan Garcia-Franz, Wisconsin Well Woman Program Coordinator at Planned Parenthood for Outagamie and Sheboygan counties, and one of the leaders of the HealthWatch Wisconsin Tri-County Coalition.
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It’s Susan’s job to make sure women are enrolled in programs they qualify for, coordinate services for them, and follow up to ensure women receive the services they need. She also works on community outreach, making sure women in under-represented populations get the information they need to make informed decisions about healthcare coverage. Every month she attends a Hispanic Interagency meeting and meets with other agencies that serve the Hispanic population to make sure they know about the Well Woman Program. Susan’s work at Planned Parenthood of Wisconsin is helping a client base of more than 650 women in Outagamie, Sheboygan, Winnebago, and Fond du Lac counties. |
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Susan said the biggest challenge she faces in her work is when women fall out of the scope of the Well Woman Program. Breast and cervical screenings are covered; screenings for endometrial, ovarian, uterine, and other forms of cancer are not. In an effort to combat a lack of funding for these screenings and for younger women not covered by the Well Woman Program, Susan takes creative measures, like selling soap at local coalition meetings and public health departments, to contribute to a side fund in her spare time. Sales average about $1500 yearly. "I wear different hats, I’m a soap seller sometimes—whatever the role takes," she said.
Susan has been a part of HealthWatch Wisconsin since 2009, when she attended a public health conference that inspired her to start a coalition for the Tri-County area. In addition to her role in the Well Woman Program, filling service gaps and making sure more women are covered, she also participated in a health care reform committee in her community. "I was doing a dual role, and it just seemed like it was a natural progression when everything came together," she said. "The people that were addressing the legislation part can now focus on what we can do in the community to make things better."
She feels that HealthWatch Wisconsin is a helpful resource for healthcare advocates like herself. The Tri-County Coalition is continuing to grow, and Susan thinks it will be a helpful resource to her community. "HealthWatch really offers structure and support to assess the common barriers that we all are having, how we can get at them and sometimes accessing community resources," she said. "We’re hoping to keep that momentum going." |
Coalition Roundup
Click here for a list of upcoming coalition meetings.
The Dane County HealthWatch's March 7 meeting has been canceled because it falls on the first day of the HealthWatch Wisconsin Annual Conference at the Best Western Inn on the Park in Madison. The group has compiled a list of speakers for April and beyond and is planning to do an asset mapping session this spring to streamline coalition communication. The next meeting will be Monday April 4 at the Waisman Community Outreach Center at 122 E. Olin. For more information about the Dane County's Coalition, please contact Adam VanSpankeren.
The Milwaukee HealthWatch Coalition will meet Wednesday March 9 to welcome Katherine Quinn of the Milwaukee Health Department. She will give an overview of Project LAUNCH, 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. For more information about the Milwaukee HealthWatch Coalition, please contact Nora Foshager.
The Pierce County HealthWatch Coalition continues to develop. On a March 10 conference call, the steering committee will pick a time and location for the kickoff meeting and determine who should be their first guest speaker. For more information about the Pierce County HealthWatch Coalition, please contact Lisa Raethke.
The Dunn County HealthWatch Coalition’s February meeting had to be 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.
The Tri-County HealthWatch Coalition had their community input meeting on February 22 – over thirty people came, representing various community organizations, health care providers, public health divisions, and local government representatives. The Coalition identified strengths and barriers to health care access and coverage in the Tri County area and worked up a plan to address those barriers. Follow up on the issues raised at the meeting will continue until Tri-County’s strategic planning meeting on Tuesday, March 29. In the meantime, please check out Susan Garcia Franz’s member profile, above, and remember, she’ll also be a presenter at the HealthWatch Wisconsin Annual Conference on Monday! Contact Susan directly for more information on Tri-County HealthWatch. |
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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 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.
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Ops Memos
Ops Memo 11-06: 2011 Federal Poverty Level Changes for the Wisconsin Shares Child Care Subsidy Program, Wisconsin Works (W-2) Program, and Related Programs
Released February 16
New Policy: The financial eligibility limit for new Wisconsin Shares applicants is 185% FPL, and financial eligibility may continue until income reaches 200% FPL. Foster and adoptive parents’ financial eligibility depends on the child’s/children’s natural family income being no more than 200% FPL at the time the child was removed from their previous home. FPL adjustment also affects child care co-payments, which will be released at a later date.
Ops Memo 11-09: Verification of Medical Expense for FoodShare
Enacted February 24
New Policy: Unlike shelter and dependent care costs, medical expenses must be verified in a FoodShare application. During the certification period and at time of renewal, changes in medical expenses that are more than $25 must also be verified. |
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State & National News
Analysis & Comment
Gov. Walker Unveils State Budget (continued from above)
On Tuesday, March 1, Governor Walker presented a brief budget address calling for the "return of frugality." There was little attention to detail on BadgerCare and Medicaid programs. Instead, the Governor said that safety net programs would be “altered so that participants who move into the workforce will be asked to pay for more of the program’s costs as they get jobs with private companies that provide health insurance.” The Walker budget presents several vague goals:
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Offer multiple, customized benefit plans tailored to the needs of specific populations and bring the coverage of working families back in line with private insurance.
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Manage the care provided to high-needs individuals to prevent avoidable complications and reduce the provision of unnecessary services.
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Develop innovative models of service delivery to realign provider incentives with better outcomes, and coordinate care covered by Medicare and Medicaid to better meet the needs of recipients.
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Expand programs that encourage and support the self-direction of services, giving individuals the opportunity to decide how and when services are delivered to best meet their needs while promoting the efficient use of benefits.
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Develop systems to encourage and reward individual responsibility by assisting recipients in making healthy lifestyle choices, managing their benefits effectively and avoiding unnecessary care.
The HealthWatch Update Staff will work to get to the bottom of what this all means. Here's what it could means for Wisconsin individuals and families:
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Increased BadgerCare Plus Premiums for the Core Plan (to start). If waivers were granted by the Federal Government, more entitlement programs would see increased cost sharing;
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Increased co-pays; and
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Preclusion from participating in BadgerCare Plus by many families who have access to employer coverage.
The detail of the "reduced expendiatures" in the Department of Health Service's budget has been made available. It is here where the DHS budget detail shows the projected cuts/savings totaling $500 million. Most notably, the budget anticipates saving $48 million per year by transferring administration of income maintenance from the counties to the state.
The Governor also recommends "increasing efficiency" in the Medical Assistance program by making the following changes:
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Limiting Medicaid reimbursement for end stage renal disease;
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Eliminating Medicaid payments for family planning services for men;
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Limiting payment of coinsurance for services under Medicare Part A;
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Eliminating supplemental payments to essential access city hospitals; and
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Requiring individuals enrolled in SeniorCare to also enroll in Medicare Part D.
To read a summary of the full budget, click here. Senate Minority Leader Mark Miller has posted a response online.
What Gov. Walker's Budget Repair Bill Means for Medicaid/BadgerCare
Governor Walker’s proposed budget repair bill takes power over BadgerCare/Medicaid away from elected officials and gives it to the Department of Health Services (DHS). The bill allows the Secretary of the DHS to make broad changes to BadgerCare/Medicaid eligibility and services behind closed doors, without public comment or legislative review. Click Here to visit our webpage on the budget repair bill.
At least for now, the budget repair bill is "on hold" until quorum can be reached in the Wisconsin Senate. That will have to wait until the 14 Democratic Senators return to Wisconsin. To hear from the Senators, be sure to join the HealthWatch Wisconsin Conference, March 7 & 8. See above for additional information.
Medicaid and BadgerCare Recipients Held Hostage?
Governor Walker released a memo last Thursday stating that the "long term sustainability of Medicaid" is in jeopardy without the passage of the budget repair bill. HealthWatch Wisconsin's Bobby Peterson replied, in a press release, "The Walker Administration is now using the 1.2 million individuals enrolled in BadgerCare and Medicaid as political hostages. The Walker Administration should stop scaring and threatening the people that need health care coverage in Wisconsin. Health care should be a right NOT a bargaining chip."
Click here to read Walker's memo.
Click here to read the press release.
Click here to watch the HealthWatch WatchDog on this topic, filmed on location at Capitol Square.
Related articles: Walker warns Medicaid payments to nursing homes could be delayed if bill not passed, Shawn Doherty, Capital Times, 24 Feb. 2011
Headlines
Obama Supports Easing Health Law Mandates for States
Sheryl Gay Stolberg and Kevin Sack, New York Times, 28 Feb. 2011
Predident Obama told the National Governor's Association that he supported modifying the health care law to allow states opt out.
Report: State Medicaid enrollment soaring
David Wahlberg, Wisconsin State Journal, 27 Feb. 2011
Enrollment in Wisconsin's Medicaid programs, including BadgerCare, has increased substantially during the last few years, according to a report released today by the Wisconsin Taxpayers Alliance.
Disability rights activists stage protest inside state GOP headquarters
Shawn Doherty, Capital Times, 26 Feb. 2011
Disability rights activists from around Wisconsin protested at the state Republican Party headquarters in Madison on Saturday.
Wisconsin union battle masks Medicaid tensions
Christopher Weaver, Kaiser Health News, 25 Feb. 2011
Senator Kathleen Vinehout predicts that, if Walker's budget bill passes, a "large numbers of people will lose BadgerCare," a component of Wisconsin’s Medicaid program.
Those other parts
Editorial, Milwaukee Journal Sentinel, 24 Feb. 2011
"Our fear is that people - irrespective of need - will be bumped off the health care rolls, only to have them show up in emergency rooms for care. Hospitals will pass on costs to those with insurance."
In GOP-led states, health-care law inspires attacks and accommodations
N.C. Aizenman and Amy Goldstein, Washington Post, 21 Feb. 2011
Governor Walker is not alone: Republican lawmakers in many states are making efforts to undermine the health care law.
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