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Vol. 7, No. 10
June 1, 2011
In this issue:
It's Time to Join or Renew Your HWW Membership!
July Immigrant Health Coverage Issues Training
Joint Finance Committee Cuts Medicaid
More from Joint Finance
State & National News
On our website:
Upcoming Coalition Meetings
Save the Date: July 21!!
Immigrant Health Coverage Issues Training - Free for 2011-2012 HWW Members!
Don't forget - when you join HealthWatch Wisconsin, you are eligible to view the Immigrant Health Options training for FREE. This year, the training will be a live, interactive webcast. The Immigrant Health Options Training is a member favorite that explores the health care coverage options available to non-qualified immigrants in Wisconsin.
The webcast will air LIVE on July 21 at 9:30 am, and viewers will be able to submit questions as it plays.
Not available to watch on July 21? Don't worry! After the live showing, the Immigrant Health Options webcast will be available on-demand to HWW members in the HealthWatch Wisconsin Training Portal.
Stay tuned for more information!
Joint Finance Cuts Medicaid
Last Tuesday, the Joint Finance Committee followed Governor Walker's recommendation to cut more than $466.6 million from Medical Assistance. The details of the cuts are unknown, being identified as "various unspecified changes" in the budget papers.(Budget paper 340, 341). As predicted, Joint Finance implemented a passive review process that will occur through the budget committee, both removing the full legislature from a review process and repealing a budget repair bill provision that would have required DHS to go through normal rulemaking processes. The way that Medicaid was handled in the budget was different from how the Legislative Fiscal Bureau was used to doing business. In one of the budget papers, the LFB writes: “In the Governor's 2011-13 budget, the administration did not present the Legislature with a traditional budget analysis for the MA program. Instead, the administration presented a single funding request that merged current law assumptions with the estimated fiscal effects of program changes the administration intends to implement in the 2011-13 biennium. Working with the administration, this office has attempted to separate the funding changes relating to maintaining the current MA program from the savings DHS expects to generate through those program changes.”
The LFB paper gave examples of what they thought the Medicaid cuts might look like, largely, increasing cost sharing and dropping higher income children from BadgerCare Plus:
For a personalized touch on the impact of cutting Medicaid and BadgerCare programs in Wisconsin, see Joe Tarr's May 26 article in the Isthmus, "So Long, Safety Net?"
Bringing the coverage of working families back in line with employer-sponsored insurance
Reducing the crowd-out of private health insurance
Improving the management of care and coordination with Medicare
Realigning provider incentives
Improving provider integrity
Making changes to eligibility criteria
HealthWatch Public Hearings: The Human Impact of Medicaid/ BadgerCare Cuts in Wisconsin
HealthWatch Wisconsin has posted the complete video footage of public testimony on the impact of proposed BadgerCare+ and Medicaid cuts that will affect 1.2 million Wisconsinites covered by these programs. In March, HealthWatch Wisconsin sponsored two days of public hearings during the HealthWatch Wisconsin Annual Conference, drawing hundreds of people to listen, learn, and for some, to share their stories and the stories of loved ones. HealthWatch Wisconsin staff was on hand to record participants' testimony.
View the public testimony footage online.
More From Joint Finance
Family Care: Joint Finance passed a motion prohibiting DHS from enrolling more people in Family Care. The motion states that no more people can be enrolled into Family Care, Family Care Partnership, PACE or IRIS programs than the total number of persons participating in all of those programs in that ADRC region (Budget paper 342). DHS could only enroll people in the long-term care programs that are offered in that person's county of residence. The enrollment cap would not apply after June 30, 2013. DHS could enroll any individual into the Family Care-related programs who is relocated from a nursing home, intermediate care facility for the mentally retarded, or State Center for People with Developmental Disabilities if the individual has resided in the facility for at least 90 days, the facility is not licensed, an emergency exists or the facility is closing or downsizing. In addition, DHS is required to do a cost-effectiveness study of the programs compared to one another and to standard MA card services.
SeniorCare: Joint Finance reversed Governor Walker’s SeniorCare position, no longer requiring eligible seniors to sign up for Medicare Part D. (Budget paper 344). Finally, Joint Finance approved a motion requiring DHS to study the effectiveness of using a competitive bidding process for generic drugs. The Committee will be off today returning Thursday, Friday and possibly Saturday, to try to stick to Co-Chairs Vos and Darling’s goal of finishing this week.
IM: Still to be discussed: Joint Finance Agenda Items still include the Centralization of Income Maintenance and the transfer of FoodShare to the Department of Children and Families. (Budget paper 355)
Paper Free Social Security by 2013
The Social Security Administration is well into a new advertising campaign to help spread the word about new federal benefit and non-tax payment methods. In an effort to encourage more individuals to receive their Social Security or Supplemental Security Income (SSI) payments by direct deposit, the Administration has created a Star Trek-inspired public service announcement they are calling "Go Direct." Two familiar faces, George Takei (Ensign Sulu) and guest Patty Duke, encourage payment by direct deposit or Direct Express. As George says, "You’ll get your payment at warp speed.”
The U.S. Department of the Treasury announced the new rule that will extend the safety and convenience of electronic payments to millions of Americans and phase out paper checks for federal benefit and non-tax payments by March 1, 2013. Anyone applying for benefits on or after May 1, 2011 will receive their payments electronically, while those currently receiving paper checks will need to switch to direct deposit by March 1, 2013. To learn more about direct deposit or the Direct Express Debit MasterCard card, or to apply, visit www.GoDirect.org.
All Aboard! This Summer, Join Up with the BadgerCare+ Express!
HealthWatch continues to plan the “BadgerCare+ Express,” a coordinated, statewide tour of low-enrollment or uninsured areas where HealthWatch Wisconsin staff, members and leaders will educate consumers and service providers about the enrollment, legal and administrative hurdles that families encounter with BadgerCare+ health coverage programs. HealthWatch hopes to make six BadgerCare+ Express stops across Wisconsin, meeting with families and professionals, providing consumer assistance, and most importantly, conducting education on BadgerCare+ programs, complete with printed “3 Steps to Family Health Coverage” kits.
In select locations, ABC for Health's staff will convene workshops for individuals, families, and health care professionals to work through the “3 Steps of Family Health Coverage,” to help promote an understanding of the legal requirements of how to get, use, and keep health coverage. Included in these stops, where appropriate, are counseling sessions, going through eligibility requirements, completing applications, troubleshooting denials, facilitating renewals, and conducting education on other health care coverage programs.
Join us in the final stages of planning or sponsorship: if you know of any local end-of-summer events where the BadgerCare+ Express should stop or would like to help out with organizing a stop, please let us know! The Madison stop of the BadgerCare+ Express will be co-sponsored by the Dane County HealthWatch Coalition and the Dane County Bar Association. The Milwaukee event will occur during Child Health Week, with co-sponsorship by the Milwaukee HealthWatch Coalition. We will announce the remaining stops soon! HealthWatch is eager to begin this very popular and successful model of enrollment and education for complicated BadgerCare+ and Medicaid coverage programs.
Leah Jepson, Ecocultural Family Interview Project Coordinator
Leah Jepson is a program coordinator at the City of Milwaukee Health Department and is currently managing the Ecocultural Family Interview (EFI) Project embedded within the Empowering Families of Milwaukee (EFM) home visitation program. Working with two professors from UCLA and her Academic Partner from the UW-Madison School of Social Work, Leah’s project involves talking to families about their routines, including how they make ends meet and navigate through the system.
Rather than a formal questionnaire or assessment form (often used in this type of research), the EFI is an informal, directed conversation intended to uncover strengths and barriers that affect how the family meets their needs. “We’re getting at some important information that doesn’t necessarily come out when we’re doing typical assessments and home visits,” she said.
The project began two and a half years ago, and Leah and her team are now starting to analyze the data. The project’s goal is to study whether talking with families this way can lead to better information, and therefore better care plans. The interviews also help them see what issues the families are facing, what they are doing to overcome obstacles, and how they can best make changes to help Milwaukee families.
The EFM Program is also collaborating with ABC for Health and HealthWatch Wisconsin to provide training to the EFM home visitation staff on health care programs and advocacy.
Outside of her full-time job, Leah is a member of the Milwaukee Child Abuse Prevention Services Committee (MCAPSC), a public policy advocacy group with which she has been working to create and maintain a community-wide resource guide for parents. She collaborates with the Homeless Education Program at Milwaukee Public Schools to update and distribute the guide annually.
Leah is currently serving as Co-Chair for the Milwaukee HealthWatch Coalition and has been an elected member of the statewide HealthWatch Wisconsin Council since 2008. She’s been a member of HealthWatch since 2005 when she started her position at the health department.
The Milwaukee Coalition, led by Leah and Celeste Schultz, is revamping its structure. “We’re breathing new life into it and trying to get new faces around the table,” Leah said. They plan to revise their mission and create organizational rules and a strategic plan to guide its progress and provide more order and consistency.
From an advocacy standpoint, Leah is passionate about health care access for women, children, the undocumented and childless adults. She also has concerns about cuts affecting health care programs, including the 90,000+ people on the waiting list for the Core plan, and the closing of new enrollment for the BadgerCare Basic plan.
She said that people should keep an eye on Milwaukee in the next six months to a year to see how these policies affect a population. “Milwaukee is usually where everything gets magnified, where you can really see the impact of even small programmatic changes…Bit by bit I think services are being chipped away, and it’s going to have a pretty big impact.”
Click here for a list of upcoming coalition meetings.
The Chippewa County HealthWatch Coalition met on May 10 at the Chippewa County Courthouse. Mike Rust of ABC for Rural Health came and spoke to the group about all of the ins and outs of HealthCheck treatment options for Medicaid-enrolled children. The next Chippewa County HealthWatch Coalition meeting is on September 13, 2011. For more information about the Chippewa County HealthWatch Coalition, please contact Rose Marsh.
Dane County HealthWatch Dane County HealthWatch meets this coming Monday, June 6 at the Waisman Community Outreach Center in Madison. Josh Weisbrod from the HIRSP Authority will be coming to speak to the group about recent developments at HIRSP, including recent enrollment and premium increases. Dane County HealthWatch will also be continuing its discussion of the non-emergency medical transportation contracts and the centralization of economic support services. The coalition will also be looking at planning something fun for the summer and discussing the BadgerCare+ Express. For more information about the Dane County HealthWatch Coalition, please contact Adam VanSpankeren.
The Milwaukee HealthWatch Coalition will meet Wednesday, June 8, to welcome Wisconsin Medicaid Director Brett Davis. The format of the first half of the meeting will be a brief opportunity for him to make remarks and then an opportunity for HealthWatch members to share their ideas for quality improvements and efficiencies, as well as to give general feedback. The second half of the meeting will be reserved for general coalition business. The Milwaukee HealthWatch Coalition meets on the second Wednesday of each month from 9:30-11:30am at Aurora Family Service (3200 W. Highland Blvd.; Milwaukee, WI 53208). For more information about the Milwaukee HealthWatch Coalition, please contact Nora Foshager.
The Pierce County HealthWatch Coalition steering committee met last week to lay out some plans for the future of the Pierce County HealthWatch Coalition. They are planning to continue to meet at the Crossroads Church in Ellsworth. The coalition will meet on the 3rd Thursday of September, January, and May, with September's speaker already confirmed: Jena Most from the Reproductive Health Division of the Pierce County Health Department to discuss Family Planning Other Services and the Wisconsin Well Woman Program. For more information about the Pierce County HealthWatch Coalition, please contact Lisa Raethke.
Covering Kids with Special Needs
The National Youth Leadership Network announces their new curriculum: Reap What You Sow: Harvesting Support Systems Curriculum Training Packages. Reap What You Sow brings youth and adults together to build support systems. For more information, click here.
June 10. Deadline for Family Scholars Program Applications. Association of Maternal & Child Health Programs (AMCHP). If you have any questions, please contact Michelle Jarvis via email or by phone at (202) 775-1472.
July 25-27. Leadership, Legacy, and Community: A Retreat to Advance Maternal and Child Health (MCH) Scholarship and Practice. Hyatt McDonald's Lodge, Oak Brook, IL. Learn more information here, or register here.
September 21. Making Connections: Care in the Community Conference. Radisson Hotel, Wauwatosa, WI. Topics will include advocacy, mental health, transition and a health benefits update. For more information, visit maxishare.com.
State & National News
Analysis and Comment
Examining the General Fund Tax Omnibus in Wisconsin:
The roll-back of the “dependent coverage mandate” was rolled into the budget
Introduced in Tuesday’s Joint Finance Committee meeting was the GOP motion on general fund taxes. Joint Finance voted along party lines to approve Governor Walker’s recommendation to offer tax cuts to some corporations while cutting back the Earned Income Tax Credit benefits for low income families. The motion creates a deferral for capital gains reinvested in qualified Wisconsin businesses ( LFB paper 310, LFB paper 311) while simultaneously modifying the percentages used to calculate the Earned Income Tax Credit. (The motion decreased the percentages for claimants with two children from 14 percent to 11 percent, and decreased the percentages for claimants with three or more children from 43 percent to 34 percent.) (LFB paper 312)
Tucked into the General Fund Tax Omnibus was also the following: the repeal of Wisconsin’s current dependent coverage law. A private insurance mandate in Wisconsin, incorporated in the 2009-11 budget, required private health insurance policies and self-insured governmental plans to provide coverage for an adult child as a dependent if the child was between 17 and 27 years of age, the child was not married, and the child was not eligible for coverage under a group health benefit through the child's employer. Instead, this week, Joint Finance voted to require that every insurer provide coverage through a disability insurance policy that provides dependent coverage of children, provide coverage for a child of an applicant or insured as a dependent of the applicant or insured if the child is under 26 years old. Sound familiar? Recall a series of bills sponsored by Sen. Vukmir (R-Wauwatosa) and Rep. Nygren (R-Marinette) to eliminate state insurance mandates, examined in an earlier edition of the HealthWatch Reporter. That proposed legislation (LRB 1529 and LRB 373) would have undone the hard-fought consumer protections written into our laws to protect our most vulnerable populations, including autism coverage, maternity, diabetes, cochlear implants, and dependent coverage. The bills would have allowed 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. In fact, the bills did not get much traction in the capitol. Neither did LRB 0867, an act to repeal dependent coverage and adopt, instead, federal law to exclude from an employee’s income payments from an employer related to medical care. This week, the roll back of the dependent coverage mandate was rolled into the budget and approved by Joint Finance, in a vote that followed party lines.
HHS to lower premiums for high-risk pools
Sam Baker, The Hill, 31 May 2011
"In addition to easing enrollment criteria, the department said it would lower premiums in 18 of those 23 states to bring them more in line with the average cost of an individual plan there. The high-risk pools’ low enrollment was attributed in part to the high cost of the plans — which, by design, cover only the most expensive patients."
Republican governors move ahead on health exchanges
Sarah Kliff, Politico, 29 May 2011
"It’s a delicate balancing act for Republicans who, on the one hand, oppose federal health reform, even challenging its constitutionality in federal court, and, on the other hand, are pragmatically trying to control as much of the implementation process as they can."
State lags neighbors in needy children's dental care
Guy Boulton, The Milwaukee Journal Sentinel, 28 May 2011
"The state's performance lagged Minnesota, Iowa and Illinois in a report released last week by the Pew Center on the States. And it did no better than states such as Mississippi and West Virginia."
So long, safety net?
Joe Tarr, The Isthmus, 26 May 2011
"In other words, the state needs to restrict enrollment, keeping people who need Medicaid and the state program BadgerCare, and would qualify for it under the current system, from getting it. There are different ways of going about this."
The state of children's dental health: Making coverage matter
The Pew Center, 26 May 2011
"Wisconsin meets half of the eight policy benchmarks aimed at addressing children’s dental
health needs. Use of dental services among Medicaid-enrolled children remains stubbornly
low, with just three in 10 children receiving care. Likewise, Medicaid payment rates remain far
below the benchmark."
The impact of premiums on families in BadgerCare Plus
Joan Alker et al, Georgetown University Center for Children and Families, 24 May 2011
"We modeled two possible scenarios which estimate the impact of charging premiums from three to four percent of families’ incomes on participation rates in BadgerCare Plus. Our findings suggest that such changes would result in between 49,422 and 87,298 fewer children and their parents participating in BadgerCare Plus."
Vermont steps closer to single-payer health care
NPR, 22 May 2011
"The federal government, Vermont's state government and employers will all still pay in for health insurance. That money will then all flow through Green Mountain Care, Vermont's official health insurance. To equalize the rates consumers pay, the state will ask the federal government for Medicaid waivers."
Retirees face squeeze on health care costs
Guy Boulton, The Milwaukee Journal Sentinel, 21 May 2011
"Women who retired last year will need an average of $93,000 in savings to pay for health care expenses in retirement, according to an estimate by the Employee Benefit Research Institute. Men will need $65,000."
Keeping coverage continuous: Smoothing the path between Medicaid and the Exchange
Kaiser Family Foundation, 20 May 2011
"A key challenge for those implementing the reform law is how to manage churning, when people cycle in and out of public programs as their income varies. What approaches are states and the federal government taking to minimize the disruption from churning? Will people be able to keep their provider as they move from Medicaid to private coverage and back?"
Feds threaten state with loss of FoodShare funds over privatization
Jason Stein, The Milwaukee Journal Sentinel, 20 May 2011
"Ollice Holden, a Midwest administrator for the USDA's Food and Nutrition Service, warned that Wisconsin had overstepped boundaries laid out for the state last year. Failing to fix the problem could lead USDA to suspend payments to the state for administering FoodShare and seek to recover certain money already paid to Wisconsin, he said."
Insurance commissioner moves to undo rule
Guy Boulton, The Milwaukee Journal Sentinel, 18 May 2011
"The Office of the Insurance Commissioner cited the cost to the industry and the pending changes under federal health care reform as two of the reasons for issuing its emergency rule."
Health care ills infect 2012-bound Republicans
Reuters, 18 May 2011
"But unhappiness over health care has now begun to infect Republicans seeking their party's presidential nomination -- particularly concerns about Republican efforts to revamp Medicare, the popular health care program for older Americans."
Government urges appeals court to uphold health care law
Associated Press, 18 May 2011
"The Obama administration said Wednesday that health care reforms should be upheld in the courts because the costs of the uninsured are a burden on interstate commerce."