In this Issue...

This week's edition of the HealthWatch Wisconsin Update is filled with breaking news! DHS has just sent its proposed cuts to Joint Finance for its "passive review," OCI wants a waiver from health reform requirements and ABC for Health is unveiling the Pathway Plan for 2012-an alternative to DHS's cuts. Read more!

Workshop is Just Two Days Away!!

Last Chance to Register

Register today for HealthWatch Wisconsin's "5 Things to Watch" workshop! Join knowledgeable speakers and special guests in Madison to discuss:

1. Wisconsin’s Federal Waiver Request-A Critical Review of the Smith Plan, and New Ideas
2. Health Reform Implementation and Health Exchanges-A Look at the Numbers
3. Infant Mortality and Birth Cost Recovery
4. The Status of Public Health Money in Wisconsin
5. Managing Managed Care-Wisconsin Oversight is Questioned

What: HealthWatch Wisconsin's "5 Things to Watch" Workshop Click Here for an AGENDA

When: Thursday, November 3, 2011, 9:30am-12:00pm

Where: Boys & Girls Club of Dane County Allied Family Center, 4619 Jenewein Road, Madison, WI

Register: Register Online, Download a Registration Form, or Call: 800-585-4222 ext. 204

Cost: Discounted rate of $15 for HealthWatch members and subscribers. Other rates apply for non-members.

BONUS!! HealthWatch Wisconsin will be conducting our next Green Bay Packer Ticket Prize Drawing at the workshop! All individual HealthWatch members are eligible to win! Not a member? Join when you register for the workshop or click here to join now! The Green Bay Packer indoor deluxe club seat tickets are for the November 20, 2011, 12:00pm game at Lambeau Field:

Green Bay Packers vs. Tampa Bay Buccaneers

The workshop will occur in tandem with the fall meeting of the HealthWatch Wisconsin Council, the leadership of the statewide HealthWatch organization. Please visit the HealthWatch Wisconsin website for more details!

Vol. 7, No. 20
November 1, 2011

In This Issue:

Workshop is in Two Days!

ABC Unveils Pathway Plan for 2012, Alternative to DHS Proposes Cuts

Breaking News: Joint Finance on the Clock

Wisconsin Insurance Commissioner Wants Waiver

Update-Consumer Assistance Grant Termination

Grapevine

HealthWatch News

NEW! Core Plan Waiting List Counter!

Case Tip

Ops Memo

Coalition Roundup

3 C's for CYSHCN!

State & National News

On our Website:
HealthWatch Membership
Upcoming Coalition Meetings

Footage of Public Hearings: The Human Impact of BadgerCare Plus

ABC for Health Unveils "The Pathway Plan for 2012"

An Alternative Plan to DHS's Proposed Cuts

This Thursday, at the HealthWatch Wisconsin "5 Things to Watch" Workshop, ABC for Health will unveil a plan that responds to Secretary Dennis Smith’s proposal to gut Wisconsin’s nationally recognized BadgerCare Plus program. The proposal called “The Pathway Plan for 2012,” contrasts sharply with Wisconsin’s Department of Health Service’s proposal to cut $220 million in state money (for a total of over $550 million in state and federal funds) from BadgerCare Plus. Bobby Peterson, Public Interest Attorney and Executive Director of ABC for Health, says the Pathway Plan for 2012 will eventually cover all Wisconsin residents while providing high-quality care, continued choice, and strong consumer protections. “While building from a solid foundation, the Pathway Plan for 2012 will use private and public partnerships to expand health care coverage, significantly lower costs, and reshape the delivery of coverage that will ensure that all Wisconsinites have access to both coverage and quality medical services.”

On September 30th, Secretary Smith and the Walker administration proposed drastic eligibility and coverage limits to the BadgerCare Plus program and the possible termination of over 53,000 adults. “Mr. Smith proposes to model BadgerCare on a free market system that is badly misaligned with Wisconsin’s values. Despite strong bi-partisan roots of BadgerCare Plus, the program is now in the hands of highly partisan ideologues. The proposed cuts will force thousands into emergency room care and could lead to the largest redistribution and socialization of uncompensated care and medical debt I have seen in over 20 years of patient advocacy. Smith proposes a bailout to a failed small group and individual marketplace and must be stopped,” Peterson continued.

The Pathway Plan for 2012 builds upon elements of Wisconsin’s popular BadgerCare Plus program: risk pooling and purchasing leverage by reshaping our current system into combined large purchasing pools. In addition, the Pathway Plan for 2012 includes the vital components of outreach, education, and advocacy through the use of Health Benefits Counselors and Health Care Navigators.

Peterson concludes, “The Pathway Plan for 2012 is the route for Wisconsin to follow. Many industries have retooled during this recession including the media, auto makers and others. The small group market with risk puddles and highly segregated risk is no longer viable. The large profit margins for these small groups of the past are gone and cannot be resurrected by destroying the large Badger Care pool. We need to give public and private partnerships and the Pathway Plan for 2012 a try.”

Breaking News: Joint Finance is now "On the Clock" for Passive Review of Proposed Cuts

DHS Sends Proposed Medicaid Cuts to Joint Finance

In the late afternoon hours of Halloween, Wisconsin's Department of Health Services Secretary Dennis Smith delivered his compiled list of proposed cuts (part 2 and part 3) of Wisconsin's Medicaid and BadgerCare Programs to Wisconsin's Joint Finance Committee. Formally called a "passive review request," Joint Finance Committee members have 14 days to review the materials. Committee members were instructed to inform Joint Finance Co-chairs Sen. Darling or Rep. Vos by November 17 if they had any "concerns" about the request, and if they thought a meeting might be necessary. By Tuesday morning, November 1, an objection to the proposal was raised, and thus a meeting of the Committee will need to convene. Read the objection letter here.

Public Expresses Frustration with DHS Proposal, Limited Comment Period

This step falls on the heels of "public meetings" that provided Secretary Dennis Smith and Deputy Kitty Rhoades with overwhelming "disapproval" of the proposal DHS put forth on September 30 to "save money" for BadgerCare and Medicaid. In his testimony, ABC for Health's Bobby Peterson said, "The proposed cuts are the largest shift of expenses to the public and private sector I have seen in over 20 years of work as a lawyer for people seeking health care coverage and services. To cut $550 million in state and federal funds means health coverage costs will be redistributed and socialized to the private sector." In response to the DHS proposal, Bobby Peterson drafted "The Pathway Plan for 2012," a way to grow the health care pool and spread the risk, while maintaining and valuing consumer protections. The Pathway Plan for 2012 will be debuted at HealthWatch Wisconsin's "5 Things to Watch" conference this Thursday.

Proposed Cuts Amended Before Sending to Joint Finance

Secretary Dennis Smith, as reported by the Milwaukee Journal Sentinel, has "made some slight adjustments" to the proposal since its September 30 debut. The Journal reports that these changes "reflect testimony given in public forums in Madison and Milwaukee." The changes included:

• The state wants to be able to count all the people living in a residence to determine how much income a Medicaid applicant has and whether he or she qualifies for the program under income limits. The department changed its original proposal slightly to exclude the income of people who live in a household for less than two months.
• The state would provide discounts for higher proposed premiums being charged to certain individuals or families if those families already pay for private health insurance for a different family member.

The DHS Waiver Request has not yet been submitted to the Centers for Medicare and Medicaid Services (CMS). Assuming Joint Finance completes their passive review on schedule, CMS is left with fewer than 60 days to review the waiver request. Also reported by the Journal Sentinel is the growing suspicion that the review can happen on time. "A spokeswoman for CMS couldn't be reached for comment late Monday but has said in the past that reviewing such waiver requests can take up to 90 days or in some cases more if the federal agency needs more information." Representative Richards is quoted as saying, "Were they ever serious about getting this waiver and trying to work this out or was the waiver just a political sideshow?"

The state budget says that if the waiver isn’t approved by Dec. 31, 2011, those parents on BadgerCare Plus and adults on the Core Plan above 133% FPL will be dropped. If CMS needs more time, Wisconsin state law would need to be amended to protect the 53,000 parents and adults on BadgerCare who are currently political leverage.

Proposed Cuts Are Appearing in the Wisconsin Administrative Register

DHS’s proposed changes are beginning to appear in the Wisconsin Administrative Register. The Register is proving to provide more detail on the individual proposed cuts initially released on September 30. See a few examples outlined below:

• Medical Assistance Reimbursement for Services Provided under the Benchmark Plan, Wisconsin Administrative Register: Mid-October 2011 (Number 670). Federal law requires States to provide emergency and non-emergency transportation services to those receiving coverage under a benchmark plan. In addition, EPSDT services are to be provided to individuals under 21 years of age. Wisconsin initially submitted its state plan amendment to assure the provision of these benefits to the federal Centers for Medicare and Medicaid Services seeking an effective date of April 1, 2010. Based on the publication date of this notice, that effective date will instead be November 1, 2011.
• Medicaid Drug Reimbursement, Wisconsin Administrative Register: September 30, 2011 (Number 669). The Department will implement Wholesale Acquisition Cost (WAC) as the pricing benchmark for brand name drugs and generic drugs without a SMAC rate. Dispensing fee amounts paid to pharmacies are not affected by the change from AWP to WAC. AWP will no longer be reported to the State by its vendor First DataBank after September 28, 2011.
• Medical Assistance Reimbursement (ESRD), Wisconsin Administrative Register: August 31, 2011 (Number 668). The Wisconsin Department of Health Services is proposing to modify the Medicaid reimbursement methodology for services provided by end stage renal disease (ESRD) providers.  The change will apply to dialysis services provided on dates of service on and after September 10, 2011.

Send your feedback to DHS! DHS has said that all written comments will be reviewed and considered. Written comments on the proposed changes may be sent to James Vavra:

• FAX: (608) 266−1096
• E−mail: james.vavra@dhs.wisconsin.gov.
• US Mail: Attn: James Vavra, Bureau of Benefits Management, Division of Health Care Financing, PO Box 309, Madison, WI 53701−0309.

Wisconsin's Insurance Commissioner Wants Waiver 

Wisconsin's Commissioner of Insurance Ted Nickel sent a letter last Tuesday 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 customer’s 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, to "protect consumers" who would otherwise "lose access to meaningful choices and affordable coverage." He expressed concern that insurance companies, such as Golden Rule and Time Insurance Company would be challenged to make significant and potentially inappropriate cuts in their expense structures in order to remain in business. "Without this adjustment, there is a reasonable likelihood that market destabilization and, thus, harm to consumers will occur...In 2010, six insurers representing 35% of the individual market and 68,310 covering lives had MLRs that fell below 80%." Currently, 65% of Wisconsin's insurance market meets the 80% MLR requirement.

Also of concern to the Commissioner were insurance agent commissions, a calculation required to be included in the administrative costs of insurance companies. In order to preserve commissions for agents, the Commissioner feared that some insurance companies may be forced to significantly reduce "non-claim related variable expenses...or lower premiums."

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.

After an initial comparison, HealthWatch Wisconsin calculated that the average medical loss ratio for HMOs in Wisconsin was 88.7%, with 21 of the 22 HMOs reporting on the Commissioner of Insurance's webpage that they exceeded the standard of health reform, an 80% medical loss ratio. The insurance companies represented in the Commissioner's letter, however, and the subject of his concern, are the small group and individual market plans that are mostly struggling to hit 70%. 

Medical Loss Ratio

HealthWatch Wisconsin will continue to follow this waiver request and the implementation of other elements of health reform within the purview of the Commissioner of Insurance.

Claims Board Rules on Consumer Assistance Grant Termination

State Claims Board Decision

On October 11, 2011, ABC for Health attorneys Bobby Peterson and Erin McBride appeared before the State Claims Board, a board of equity, to address the early, unexpected termination of ABC’s Consumer Assistance Program grant by the Office of the Commissioner of Insurance (OCI) back in March.

On October 26, the Claims Board released their minutes from that hearing, which include their conclusion, "There has been an insufficient showing of negligence on the part of the state, its officers, agents or employees and this claim is neither one for which the state is legally liable nor one which the state should assume and pay based on equitable principles."

Not surprised by the decision, ABC for Health attorney Bobby Peterson stated, "We completely expected this decision from the Claims Board, a group of Gov. Walker appointees and supporters. This is another attack on Wisconsin's health care consumers. We are evaluating next steps, which may include legal action."

The State Claims Board is made up of 5 members, including a representative of the Governor's Office (Brian Hagedorn), Department of Administration (Gregory Murray), Attorney General (Steve Means) as well as a member of each house of Wisconsin's legislature (Sen. Pam Galloway and Rep. Pat Strachota). The representative of the Governor's office recused himself from the decision, since his office was directly named in the complaint. For more information on the history of this issue, please refer to ABC for Health's consumer assistance grant webpage.

Grapevine

AB 210 Stalled in the Senate

HealthWatch Wisconsin has been following AB 210, the Bill relating to the "implementation of health insurance reform, providing an exemption from emergency rule procedures, and granting rule-making authority." AB 210, touted as the bill to “bring Wisconsin into compliance with the Affordable Care Act,” instead abandons the progress Wisconsin has made to create a transparent process for consumers. The Bill also provides for an unwarranted delegation of rule-making authority to Wisconsin’s Commissioner of Insurance (OCI) to create and disseminate rules as “emergency rules” that may remain in effect for decades. The emergency rules may be promulgated without the usual finding of emergency required under current law, and extend the reach of the Commissioner, without the legislature, to create policy.

After working through the Assembly, the Bill has stalled in the Senate. The reason? There may be many. More progressive members of the Senate don't want to hand the keys to health reform over to Commissioner of Insurance Ted Nickel. The more conservative members don't want a vote for "ObamaCare" on their record.

The Timeline:

• September 15: Lengthy public hearing in the Assembly Insurance Committee
• October 18: AB 210 is approved by the Assembly
• October 25: Senate Committee on Insurance public hearing
• Today: Stalled

UPDATE: Where's the Medicaid Audit?

In the last edition of the HealthWatch Wisconsin Update newsletter, we asked the question, "Where's the Audit!" Recall, in January 2011, Wisconsin's Joint Legislative Audit Committee requested a "sweeping audit" of Wisconsin's Medicaid and FoodShare programs to be carried out by the Legislative Audit Bureau (LAB), the first such audit since the LAB issued its last program integrity report in 2008.  Many advocates and policy experts expected DHS to use the audit as the basis for potential Medicaid reforms and recommendations. Despite these sensible expectations, DHS proceeded with a new Medicaid Waiver proposal with dramatic program changes. What happened?!

Thanks to the Audit Bureau for a very quick and polite reply to a HealthWatch Wisconsin inquiry. The Bureau replied they hoped the audit would be concluded and a report released by the end of the calendar year. HealthWatch will continue to follow up with Department of Health Services to see why the proposed cuts pre-date the audit recommendations, and will report back any findings in future editions of the Update.

HealthWatch News

Save the Date! The HealthWatch Wisconsin Annual Conference will be February 27 & 28!

Join us in Madison this coming February for the 5th Annual HealthWatch Wisconsin Conference! Mark your calendar for Monday and Tuesday, February 27 & 28  as we discuss topics along this year's theme: "Waive Goodbye to Medicaid?" Watch your inbox in the coming weeks for an announcement of when registration for the great event will open.

Now Open: Nominations for HealthWatch Wisconsin's Annual Awards!

HealthWatch Wisconsin is currently accepting nominations for the Third Annual HealthWatch Awards to be presented at the HealthWatch Wisconsin annual conference luncheon on Tuesday, February 28, 2012. The Health Watch Wisconsin council seeks to recognize outstanding work in healthcare advocacy and service in four categories. Click on the category you wish to nominate someone for to download a nomination form!

• Advocate of the Year
• Elected Official of the Year
• Outstanding Outreach Effort Award
• Outstanding Media Coverage Award

To nominate someone for an award, complete the appropriate nomination form, found by clicking on the award names above. Return your form to HealthWatch Wisconsin by email, FAX: 608-261-6938 or US Mail: 32 N. Bassett St., Madison, WI 53703. To view last year’s winners, Click Here.

Join the Leadership of HealthWatch

Nominate a friend, colleague, public health hero of yours (or yourself) for the HealthWatch Wisconsin Council, the leadership committee of HealthWatch Wisconsin! We will compile nominations and prepare a ballot for the Annual HealthWatch Wisconsin conference February 27 & 28, 2012. To make your nomination, please email HealthWatch Wisconsin with your nominee's name, workplace, email and phone number.

NEW: Core Plan Waiting List "Counter"

One hundred twelve thousand, six hundred and five people, and counting

This number represents the number of childless adults in Wisconsin sitting on the BadgerCare Plus Core Plan Waiting List as of the early afternoon on October 31, 2011. These individuals should be effectively screened by the Department of Health Services/Enrollment Services Center upon entering the abyss of the waiting list for different health coverage programs, including, but not limited to, Elderly, Blind and Disabled Medicaid, Medicaid Assistance Purchase Plan, HIRSP, or SSI/SSDI.

Help Keep the Counter Current! Click Here to email HealthWatch Wisconsin with the number you or the individual you are helping has on the waiting list. Please tell us the waiting list number, and the time/date you applied.

Keeping Count: The BadgerCare Plus "Counter"

When the BadgerCare+ Express traveled Wisconsin educating families and advocates on BadgerCare Plus, we did a lot of "myth-busting!" One of our main messages was "BadgerCare Plus for Children, Families and Pregnant women is still an option for families," despite frozen enrollment for the Core and Basic Plans. The HealthWatch Update staff is keeping an eye on BadgerCare Plus enrollment for children, adults/caretakers, and pregnant women. As numbers are made available, we will update them here:

Seven hundred forty eight thousand, eight hundred and fifty-two children, adult/caretakers and pregnant women are enrolled in BadgerCare Plus as of the end of September 2011. (This number does not include adults on the BadgerCare Plus Core Plan.)

Case Tip

Using Recently Paid or Waived Bills to Meet a Deductible

Individuals applying for Medicaid or BadgerCare Plus may be required to meet a deductible to become eligible for coverage. Medical bills may be used to meet the deductible dollar amount to effectively “spend down” one’s income or assets to the eligibility levels. Individuals should be aware that medical bills that are no longer an outstanding obligation to a provider may still be used to meet a deductible. More specifically, the Medicaid Eligibility Handbook Ch. 24.7 and the BadgerCare Plus Handbook Ch. 17.4 both state that bills paid by the individual or written off by the medical provider “some time during the three months prior to the date of application” may be used to meet a deductible.

Example: Jim is applying for Elderly, Blind and Disabled Medicaid. He requires a deductible to become eligible. Jim was in the hospital two months ago, but already wrote out a check to the hospital to pay his $10,000 medical bill. Since this bill was paid within three months of Jim’s application for EBD Medicaid, the bill can still be used to meet his deductible. 

Ops Memos

Ops Memo 11-56: Transition of Enrollment Services Center Cases
Released October 31, 2011
New Policy: Beginning January 1, 2012 all income maintenance (IM) cases will be managed by the IM Consortia, the Tribal IM agencies and Milwaukee Enrollment Services (MilES). This includes the cases that are currently managed by the Enrollment Services Center (ESC). In order to meet requirements set by the Federal Nutrition Service, the transition of FoodShare  only cases from the ESC to the local agencies will begin November 1, 2011. ESC cases began transitioning to MilES effective October 1, 2011. All ESC cases will be transitioned from the ESC to the local agencies by March 31, 2012.

Coalition Roundup

Click here for a list of upcoming coalition meetings.

The Chippewa County HealthWatch Coalition meets next on Tuesday, November 8 at the Chippewa County Courthouse. The coalition is welcoming Jaime Lawrence-Olson, assistant executive director and prevention services program coordinator for Positive Alternatives, Inc., a multi-service nonprofit serving youth and families in Wisconsin.  After November, the coalition's next meeting won't be until January 10, 2012. .For more information about the Chippewa County HealthWatch Coalition, please contact Rose Marsh.

The Dane County HealthWatch Coalition has its next meeting on Monday, November 7. Dane County HealthWatch is conducting its annual food drive - if you go to the meeting, please remember to bring your canned goods and other non-perishables! The speaker will either be someone from Bureau of Long Term Support or an ABC for Health staff person, who will present on one of the topics from the "5 Things to Watch" workshop, continuing the discussion for those unable to attend.  Dane County HealthWatch is also still tracking issues with LogistiCare, as well as DHS's proposed cuts. The steering committee nomination process will conclude at the November 7 meeting, as well, with the election of a new steering committee member. For more information about Dane County HealthWatch, please contact Adam VanSpankeren.

The Eau Claire County HealthWatch Coalition will meet on November 3, 2011 at the Luther Hospital Cafeteria and are welcoming speaker Kari Francois, the community relations coordinator for Heritage Senior Living. She will be speaking on the Chippewa Valley Assisted Living Association (CVALA), a collaborative group of area professionals committed to providing education, resources and tools to help folks simply the search for assisted living in Eau Claire, Wisconsin. For more information on the Eau Claire County HealthWatch Coalition, please contact Lou Kelsey.

The Milwaukee HealthWatch Coalition met on Wednesday, October 12, 2011 at Aurora Family Service. Brad Holman from the Southeastern CYSHCN Regional Center presented on policy for children and youth with special health care needs and some of the regional center's current projects. Like Dane County HealthWatch, the group is tracking many issues, including DHS's proposed changes to MA and BadgerCare programs. Milwaukee HealthWatch next meets on Wednesday, November 9 at Aurora Family Service. Adam VanSpankeren from ABC for Health will be there to present a demo on the HealthWatch Wisconsin Training Portal. If you would like more information on Milwaukee HealthWatch, please contact Julie Dixon-Seidl or (414) 773-4646.

The Pierce County HealthWatch Coalition last met on September 15, when they heard from Jena Most, a public health nurse who works with the Wisconsin Well Woman Program and Family Planning Only Services. The group also got an update on changes coming to economic support in Pierce County from ES worker Chris Tuenge. The coalition will convene again on January 19 from 9 to 11, at the Crossroads Community Church in Ellsworth. Stay tuned to the HealthWatch Wisconsin Update for more details. For more information about the Pierce County HealthWatch Coalition, please contact Lisa Raethke.

The Tri-County HealthWatch Coalition convened on Tuesday, October 25. Though it was scheduled for the subcommittees only to meet, the full coalition ended up meeting instead. The group discussed the "5 Things to Watch" workshop, as well as recent Medicaid news for Wisconsin. The coalition has identified a pocket of people interested in women's health initiatives; Susan Garcia Franz will follow up on behalf of the coalition. Tri-County HealthWatch is also taking a look at charity care programs offered by hospitals in their area. The coalition is deciding how to focus their efforts to make the most of the rest of the year. The full coalition meets again on November 22 at Goodwill. For more information about the Tri-County HealthWatch Coalition, contact Susan Garcia Franz or Connie Raether.

3 C's for CYSHCN!

Ask a Good Question...

I received a denial from my insurance company for speech therapy services for my daughter. I thought this was a covered service. What are my immediate next steps?

...Get a Good Answer!

The best way to know what health care services you are able to access under your private health insurance is to get a copy of your health insurance policy. The policy or plan will outline what services and treatments are “covered.” Some insurers may use a catch-all provision that determines certain school related services, like certain speech therapy is not covered.

Next, take a look at the denial letter itself. If the denial does not explain why speech therapy services were not covered, draft a letter or email to the insurance company requesting more information. (REMEMBER: keep copies of all your communications!) Specifically, you should request to see the section of the insurance policy that the insurance company relied upon to deny the benefits. If other documents were used by the insurance company, ask to see a copy of those documents as well. Finally, the health insurance policy should outline your appeal rights and next steps needed to challenge any denial you feel is not proper.

Questions on this Answer?

Still not sure? Have another question? Send us an email! We may address emailed questions in the next edition of the Update Newsletter.

Events of Interest:

Is there an event missing from our list? Let us know! Email us with events, directions and details other collaborators may like to attend.

Finding Your Way: A Navigation Guide for Wisconsin Families Who Have Children and Youth with Special Health Care Needs and Disabilities has been published. Download a pdf version of the booklet here.

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.

November 3. Did you know? Now you know! Waisman Outreach Office, 122 E. Olin Ave., Madison, WI. 5:30-8:30 p.m. Training for parents, foster parents, caregivers and providers on health care and community services and supports for children and youth with special health care needs and/or disabilities. Meet other families and become more informed and empowered to get the services and supports your child needs! To register, call 800-532-3221 or email Susan at sbreitbach@waisman.wisc.edu.

November 4-5, January 13-14, February 24-25, April 20-21. Youth in Partnership with Parents for Empowerment. 5 p.m. Fridays ending by 3 p.m. on Saturdays at the Tundra Lodge Resort & Conference Center, Green Bay, WI. Youth, parents and guardians must attend all five sessions. For more information, contact Martha DeYoung at 800-862-3725 or deyoungm@cesa5.k12.wi.us.

November 5. Did you know? Now you know! ADRC of Manitowoc County, 4319 Expo Drive, Manitowoc, WI. 9:00 a.m.-12:00 p.m. Training for parents, foster parents, caregivers and providers on health care and community services and supports for children and youth with special health care needs and/or disabilities. Meet other families and become more informed and empowered to get the services and supports your child needs! To register, call 877-568-5205 or email Kara at KVanVooren@chw.org.

November 8-9. Fourth Annual Self-Determination Conference. Kalahari Resort, Wisconsin Dells. There will be lots of hands-on sessions on navigating adult systems, getting more involved in the community, supported employment and more. The $75 registration fee includes meals and materials. For more info, click here.

December 2-3, January 20-21, February 17-18, March 30-31. Parents in Partnership: A Leadership Development Opportunity for Parents of Children with Disabilities. 4:30 to 8:30 p.m. on Friday and 9 a.m. to 3:30 p.m. on Saturday at Paradise Shores Conference Center, 26364 County Hwy. M, Holcombe, WI. Parents and guardians must attend all five sessions. For more information, contact Ruth Adix at 715-864-3014 or raadix2@yahoo.com.

A Training Announcement for All CYSHCN Collaborators: The Next CYSHCN Live Web Cast is Thursday, November 17, 2011 at 10:00am

While many of you working with families will not challenge a denial or go to a fair hearing, you surely have had families ask you about the process! Fair hearings are designed to give individuals an opportunity to challenge the explanation of their denied service, coverage reduction or coverage termination. But, how do you get from the denial of BadgerCare Plus or Medicaid to the actual fair hearing? What is a fair hearing like? Is there a judge? In this webcast, we will start with a few simple examples of conversations you can have with families so they know what to expect and what it's like to go through a public coverage program appeals process. Learning objectives for this training include, how to:

• Learn some conversation starters and tips for talking to a family about fair hearings
• Understand some common scenarios and examples of fair hearings to make the process more approachable
• Become more familiar with the Medicaid Handbook and some of the rules that govern fair hearings
• Help communicate a reasonable expectation of goals to families interested in fair hearings
• Locate appropriate assistance as necessary, including community referral sources for additional information, resources and guidance on laws and statutes.

This web cast training was selected by YOU! Thank you! Through the competency self-assessment survey, you indicated that you wanted to learn more about state Medicaid benefits and programs, challenging denials and other conflicts in health coverage programs for children.

Watch your inbox for a confirmation of the date and time, future instructions, and login information! This is a live web cast, so you are able to participate, ask questions, and answer polls. Not able to join the live web cast? Don't worry, we'll share the archive link with you, and hope that you can join us again in the future.

State & National News

Analysis and Comment

The Case of the Missing $45 Million

State officials may have to come up with a new way to fund a $45 million shortfall in health care plans for the people of Wisconsin after federal officials rejected a state request to secure the dollars. A spokesperson for the Department of Health Services says they were surprised by the feds actions, expecting a check for the $45 million. The Milwaukee Journal Sentinel reported Spokesperson Stephanie Smiley as saying, "If what you sent us is in fact a denial of these waiver initiatives, DHS will need to find the additional $45 million in (state money). We do not yet have a proposal to find this savings," Smiley said. Another Health Services spokeswoman, Beth Kaplan, later confirmed that the Walker administration no longer expected to receive the money in light of the Sebelius letter.

The reality is that this money was not accounted for in the proposed cuts DHS unveiled September 30, and submitted to Joint Finance yesterday afternoon. DHS explained the money was owed Wisconsin, as the federal government had improperly enrolled people in SSI, paid for through state and federal funds, when they should have been enrolled in SSDI, paid entirely from federal funds. U.S. Health and Human Services Secretary Kathleen Sebelius refused the reimbursement request saying that she lacked the legal authority to make the payments or provide a "quick solution" to the issue.

The administration already accounted for the delivery of $45 million in federal money to cover about one-fifth of the $220 million in "savings" as determined by Walker's budget.

Editors Note: We wonder why the individuals would be directed to SSDI if they were eligible for SSI?  SSDI requires 2 years before Medicare benefits kick in. SSI includes Medicaid that begins right away. Is the state proposing to save money by directing people away from needed medical coverage?
 

Headlines

New Report Documents Health Savings to Wisconsin Consumers from National Health Care Reform
Citizen Action of WI, Nov. 1, 2011
According to a new Families USA report, co-released by Citizen Action of Wisconsin, the Affordable Care Act once fully implemented will save Wisconsin consumers on average $2040 per year in reduced health insurance premiums and cost sharing.

Capsules: Health Experts Urges States to Slow the Move to Medicaid Managed Care
Kaiser Health News, Oct. 31, 2011
As more states turn to managed care to reduce Medicaid costs, Judy Feder is urging caution.

$45 million federal check not in the mail
Milwaukee Journal Sentinel, Oct. 30, 2011
Gov. Scott Walker's administration has conceded that it will not receive a $45 million windfall from the federal government that the administration was counting on to help close a budget shortfall in the state's health plans for the poor.

HHS finalizes standards on health disparities
The Hill, Oct. 31, 2011
The Health and Human Services Department on Monday finalized new standards to track broad factors that affect people’s health.

Big Insurer Fights Back in Court Against Regulation of Profit Margin
Kaiser Health News, Oct. 31, 2011
A lawsuit challenging Maine's authority over health insurers' profit margins is drawing national attention from state regulators worried about the impact on their power to hold down rate increases.

Walker adjusts plan to close $554 million gap in Medicaid program
Milwaukee Journal Sentinel, Oct. 31, 2011
Gov. Scott Walker's administration tweaked its proposals Monday to close a half billion-dollar budget hole in the state's health plans for the poor as a deadline approaches for deciding whether the state will drop the health coverage of tens of thousands of state residents

The health care debate: popularity, probability, and facts
Yahoo, Oct. 31, 2011
What people believe about the likely impact of a given piece of legislation  can be markedly different from its actual impact.

Firms to charge smokers, obese more for healthcare
Reuters, Oct. 31, 2011
A growing number of companies have been encouraging workers to voluntarily improve their health to control escalating insurance costs.

Children's Hospital begins conversion to electronic records
Milwaukee Journal Sentinel, Oct. 29, 2011
Earlier this month, more than 400 employees of Children's Hospital and Health System spent a day at the Frontier Airlines Center planning for a project estimated to cost more than $120 million over the next five years: the health system's conversion to electronic health records.

Medicaid Innovations: Can Managed Care Cut Costs and Improve Value? [Video]
Kaiser Family Foundation, Oct. 28, 2011
How many states are planning Medicaid managed care expansions? What impact would these changes have on beneficiaries, providers and health plans? What have we learned from past efforts to expand managed care?

Medicare Part B premium hike will be smaller than expected
Reuters, Oct. 27, 2011
The premium for Part B will be $99.90 in 2012, up just 3 percent compared with this year. And the Medicare Part B deductible will be $140, a decrease of $22 from 2011.

SC Medicaid agency may reinstate dental coverage
MSNBC, Oct. 25, 2011
Dental coverage originally cut due to shortfall might be costing state more in emergency expenses.

GOP governors oppose Obama plan to cut Medicaid spending
The Hill, Oct. 24, 2011
The Republican Governors Association said that Obama’s proposal would simply shift costs to the states. Democratic governors also oppose Obama’s plan, for the same reason.

States Are Limiting Medicaid Hospital Coverage In Search For Savings
Kaiser Health News, Oct. 24, 2011
Advocates for the poor and hospital executives say the moves will restrict patients’ access to care, force hospitals to absorb more costs and lead to higher charges for privately insured patients.

House to vote on Rep. Black bill paring down health law's Medicaid expansion
The Hill, Oct. 21, 2011
The House will vote on legislation that will prevent as many as 1 million middle-income Americans from becoming eligible for Medicaid under the healthcare reform law, cutting the deficit by about $13 billion over 10 years and is expected to pass with bipartisan support.

Wisconsin will start to prepare for more budget cuts
Green Bay Press Gazette, Oct. 20, 2011
A recent letter from the Department of Administration told state agencies that $300 million in cuts is possible, a figure that includes $126 million more in possible reductions beyond what are included in the 2011-2013 state budget passed in June.

Capitol Report: Cuts signal switch in state’s approach to health care
Madison.com, Oct. 20, 2011
Tightened eligibility requirements would push some out of the state's programs and into the pricier private market.

Public speaks out against Wisconsin Medicaid Cuts
Twin Cities, Oct. 19, 2011
A plan to cut about half a billion dollars from the state's Medicaid costs put forward by Gov. Scott Walker's administration drew an overwhelmingly negative response at the first of two public hearings today.

Galloway co-sponsors proposal to make birth control education optional
Wausau Daily Herald, Oct. 19, 2011
The legislation, introduced by New Berlin Republican state Sen. Mary Lazich and supported by state Sen. Pam Galloway, would eliminate existing state law that prevents school districts from creating abstinence-only sex education programs.

Healthy Youth Alliance: Statewide groups condemn effort to repeal Healthy Youth Act
WisPolitics, Oct. 19, 2011
The Healthy Youth Alliance denounces the introduction of Senate Bill 237 that would repeal critical components of the Healthy Youth Act.

Save BadgerCare Coalition: Proposed cuts to BadgerCare and Medicaid demand more scrutiny
WisPolitics, Oct. 19, 2011
The Save BadgerCare Coalition calls on DHS to address the many concerns its members and the people they represent have raised about proposed cuts before moving forward with the waiver proposal.

Wis. bill applies federal health-care law to state
Daily Cardinal, Oct. 19, 2011
The bill, introduced by state Sen. Van Wanggaard, R-Racine, and state Rep. Pat Strachota, R-West Bend, would allow parents with dependent children to receive the same tax exemption at the state level that they do at the federal level.

Bill would change review process for health-insurance coverage denials
News Talk WTAQ, Oct. 19, 2011
The Assembly voted 57-to-39 to give State Insurance Commissioner Ted Nickel the authority to create a new process to replace the state’s long-running independent review system for insurers’ coverage denials.

U.S. healthcare system lags other countries on quality, access
Los Angeles Times, Oct. 18, 2011
Americans die far more frequently than their counterparts in other countries as a result of preventable or treatable conditions, such as bacterial infections, screenable cancers, diabetes and complications from surgery.

Deficit panel may need push, lawmakers say
New York Times, Oct. 18
The lawmakers have not agreed on basic elements like a benchmark against which savings will be measured.

Senate OKs bill limiting voucher school expansion
Milwaukee Journal Sentinel, Oct. 18, 2011
Wisconsin's school voucher programs could not move beyond Milwaukee and eastern Racine County, under a bill the state Senate approved Tuesday.

U.S. moves to cut back regulations on hospitals
New York Times, Oct. 18, 2011
Many of the new proposals deal with Medicare and Medicaid rules that have not been altered in decades. In general, the proposals do not affect the large number of rules issued under the new health care law, which set detailed standards for coverage offered by insurance companies and employers.

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