Happy Holidays, from HealthWatch Wisconsin!

With Medicaid and BadgerCare being threatened, there's never been a more important time to continue our momentum.

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In this Issue...

Happy New Year? 53,000 Wisconsities are on Tender Hooks

HealthWatch Wisconsin continues to follow the conversations between the Centers for Medicare and Medicaid Services (CMS) and Wisconsin's Health Secretary Dennis Smith. Are the people of Wisconsin caught in a Catch-22? Is it almost time to hit the panic button? Read More!

Register TODAY for the Annual HealthWatch Wisconsin Conference

Madison will be the place to be this spring! As a Presidential primary approaches and "recall fever" is in the air, we'll gather elected officials, candidates, experts and more to discuss our featured topic "Waive Goodbye to Medicaid? Not if We Can Help it!" and get perspectives on the future of health coverage in Wisconsin!

Vol. 7, No. 23
December 15, 2011

In This Issue:

Conference Registration is Now Open!

Feds reply to DHS waiver - Catch 22

How to Comment on the Waiver

Share Your BadgerCare Story!

Wisconsin's Health Care Refugees

Independent Review: A Tale of Two Rules

Feds Issue Rule on MLR

OCI Waiver of MLR still pending

Feds Reveal New Rate Website

HealthWatch News

Member Profile

Case Tip

Access

Ops Memos

Coalition Roundup

3 C's for CYSHCN!

State & National News

Headlines

On our Website:
HealthWatch Membership
Upcoming Coalition Meetings

Footage of Public Hearings: The Human Impact of BadgerCare Plus

Follow @HealthWatchWi

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Feds Reply to Dennis Smith--Wisconsin Families in a Catch-22

On Thursday, November 10, the state's waiver request was sent to the federal government for consideration. After initial, brief review, the Centers for Medicare and Medicaid Services (CMS) have exchanged letters, but still very little is know of the fate of Wisconsin's Medicaid and BadgerCare programs. If nothing changes between now and Jan1, 2012, 53,000 parents and childless adults (over 133% of the Federal Poverty Level) will lose coverage effective July, 1, 2012. If the waiver is approved at least 63,000 adults including about 29,000+ kids will lose coverage as the Walker Administration drastically retools Medicaid in Wisconsin under the CMS waiver authority and legislative authority. It's an unfair catch-22 for the people of Wisconsin.

• Journal Sentinel: Feds OK some Medicaid changes, but thousands could lose coverage
• Rep. Sandy Pasch: Federal Government, Public Need More Time to Review Extreme Walker Health Cuts
• Tammy Baldwin blasts Walker Gamesmanship on BadgerCare
• Wisconsin Council on Children & Families supports CMS's delay of decision
• Citizen Action of Wisconsin: Federal Action Does Not Shift Responsibility for Slashing BadgerCare

SPEAK UP! How YOU Can Comment on the Waiver Request:

Share your BadgerCare and Medicaid Story:

In Wisconsin, about 1.2 million people rely on BadgerCare and Medicaid programs to provide essential, affordable, and effective health care services. And the impact of these programs reaches thousands more--our friends, neighbors, grandparents,  colleagues, and health care providers large and small in every county of Wisconsin. Tell your BadgerCare or Medicaid Story! Why is BadgerCare or Medicaid important to you and your family? What would happen if BadgerCare or Medicaid ended? CLICK HERE to complete a story form!

Wisconsin's Health Care "Refugees"

A Visual Exercise

Wisconsin's BadgerCare Plus Core Plan waiting list currently has over 117,500 adults, or "health care refugees" waiting for coverage. This is over the population of Green Bay, Wisconsin. Consider the following: If the Medicaid Waiver is not "approved" as the legislature set up in its budgetary Catch-22, then add 53,000 adults to this refugee camp, or the equivalent of the population of all of Outagamie County. If the waiver is not approved and the waiting list disappears? Consider it the equivalent of dropping everyone in the city of Green Bay and Appleton combined.

Wisconsin has an uninsurance rate of approximately 11%, or the size of Brown, Calumet, Outagamie and Winnebago Counties.

Below is our usual demonstration of the Core Plan Waiting List as a counter. This number represents the number of childless adults in Wisconsin sitting on the BadgerCare Plus Core Plan Waiting List as of noon on December 14, 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.

One hundred seventeen thousand, five hundred and eighteen people, and counting

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 four thousand six hundred and eighty one children, adult/caretakers and pregnant women are enrolled in BadgerCare Plus as of the end of November 2011. (This number does not include adults on the BadgerCare Plus Core Plan.)

Independent Review: The Tale of Two Emergency Rules

You may recall from our December 1 Edition of the HealthWatch Update that Wisconsin's Commissioner of Insurance, Ted Nickel, issued an "Emergency Rule Ins. 18" to implement changes to Wisconsin's independent review and grievance procedures, and grant exemptions for insurance companies. The "finding of emergency" was effective November 16. The purpose was in part to enact changes that failed when Assembly Bill 210 never made it out of the Senate, and in other part to match the requirements of the Public Health Service Act as amended by health reform law. Apparently, the emergency was over as of December 1.

HealthWatch Wisconsin has learned that this Emergency Rule is currently in the process of being repealed. In a "statement of scope" explaining why, Nickel writes, "states can choose whether or not to demonstrate compliance with the amended federal law and regulations." Although he initially deemed it an "emergency" that Wisconsin comply with federal law, he now determined that "it is in the best interest of consumerers and insurers to retain prior regulations..." The only way to repeal an Emergency Rule is to issue a second Emergency Rule.

Editor's Note: For the same reason why Assembly Bill 210 never made it out of the Senate, we suspect theregoes Emergency Rule Ins. 18. The Walker Administration surely saw it as an attempt to implement "ObamaCare" in Wisconsin. Finding that federal compliance was not required until January 1, 2012, the administration did not want to impliment any federal law changes earlier than needed. We expect to see a third Emergency Rule on or shortly after January 1, 2012 to implement independent review changes as required by the Affordable Care Act, and avoid any penalties for noncompliance with federal requirements. In the meantime, before Emergency Rule #2 can become a permanent rule, it needs a public hearing. HealthWatch will continue to monitor the administrative steps to ensure OCI follows proper procedural procedure.

Feds Issue Final Rule on Medical Loss Ratio, Stand Up to Agents

In spite of pressure from insurers, HHS announced it will maintain the medical loss ratio (MLR) rule instituted by the health care reform act. This ruling, taking effect on January 1, 2012, requires single and group insurers to use no less than 80% of premium charges for direct coverage of medical cost, leaving 20% of charges for administrative expenses. Although this means less exorbitant costs for consumers, insurers argue that this will be an obstacle to their economic viability.

Insurers argued that anti-fraud efforts should be included in the health costs as opposed to administrative. Agents were adamant that their commissions were also considered health costs. However, on both counts, HHS deemed both to be administrative, and therefore part of the 20% calculation. How does Wisconsin stack up? Consider the following: Wisconsin has some of the highest insurance broker commissions/compensation in the entire country

In the event that records indicate that less than 80% of premiums charged were used for medical costs, insurers will be required to issue rebates or fee reductions in the amount of the difference. In an effort toward transparency, any consumers issued rebates must also be provided a description of the legal requirements of the insurer under this ruling.

OCI Waiver of Medical Loss Ratio "Still Pending"

If a state determines that meeting the medical loss ratio defined in the Affordable Care Act is too difficult, the federal government is able to adjust the ratio for that state. Yet, the state has to show that the federal rule would "destabilize the individual market." HealthWatch Wisconsin introduced this topic in its November 1 Edition of the Update, where it told how Wisconsin's Commissioner of Insurance Ted Nickel asked the federal government for one such waiver of the medical loss ratio for Wisconsin. Also recall that 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.

The federal government is still evaluating Commissioner Nickel's waiver request, in it's "review for completeness." Once the application for a waiver is deemed "complete," then a special 10 day comment period is available for the public to weigh in on the request. HealthWatch will continue to monitor the federal website to see when the Wisconsin application is deemed complete, and the 10 day comment period begins. To watch for yourself, follow this link.

Feds Unveil New Rate Website to Track Insurance Hikes

Finally, the US Department of Health and Human Services (HHS) has debuted its long anticipated website that displays rate increases requested by health insurance providers and their current status in review. Under the Affordable Care Act, beginning in September of 2011 any rate increases of 10% or greater must be submitted for approval by HHS. This new tool brings a bit more transparency to the process by allowing consumers to see beforehand any proposed increases by their providers. This, along with the medical loss ratio regulation, will help protect consumers from unreasonable health care costs. Want to see who in Wisconsin is increasing rates? Click here to view the website.

Case Tip

Tips for the Holiday Season: Will Receipt of Monetary Gifts Impact Eligibility for BadgerCare?

The holiday season is a wonderful time of giving. If you or someone you know is on or applying for BadgerCare during these months, consider the impact gifts might have on income eligibility for benefits. According to the BadgerCare Plus Handbook, monetary gifts are defined as something a person receives which is not repayment for goods or services, that are more than $30. These gifts are counted as ‘Other Income’ which in turn, is considered when determining your income in order to meet BadgerCare eligibility.

Example: Tim and his wife Maria just had a baby. The family is considering applying for BadgerCare for their child and for themselves. Tim got a check from his Grandma for Christmas of $45. When applying for benefits, Tim and his wife will need to report that check from Grandma as earned income when submitting their benefits application.

Changes to ACCESS

ACCESS.wi.gov will be DOWN from on Saturday Dec. 17th from 8:00 am until approximately 2pm for routine maintenance and changes due to the income maintenance transition to consortia. Changes/Enhancements to ACCESS include:

• Creating the ability for all members to complete a FoodShare or Child Care Six Month Report Form online in MyACCESS
• Updating contact information to reflect ten new income maintenance consortia that will manage enrollment in BadgerCare Plus, FoodShare, Medicaid, Caretaker Supplement and Family Planning Only Services.
• Routing applications for adults with no dependent children to the agency representing the individual’s county of residence rather than the Enrollment Services Center.

In the near future, DHS will be emailing more information about the six month report form project and the income maintenance transition to consortia. If you have any questions about these changes to ACCESS, please contact Claire Smith.

Ops Memos

Ops Memo 11-69: CARES Changes for the New Income Maintenance Administrative Structure
Originally posted December 7, 2011
Beginning in January 2012, the IM programs will be administered by individual tribal agencies, MilES and 10 consortia made up of groups of local county agencies. Each consortium will have a call/change center that will be responsible for updating cases for all agencies within the consortium.
Because of the new IM administrative structure, certain changes to CARES/CWW were required to ensure a seamless transition from the current structure.

Administrator's Memos

Admin's Memo 11-04: Fraud Prevention and Investigation Program Allocations and Guidelines for CY 2012
Originally posted November 17, 2011
The purpose of this memo is to provide information regarding DHS Fraud Prevention and Investigation Program Operation and Funding for CY 2012.

Providers' Updates

No. 2011-81: ForwardHealth Training Opportunities and Resources
December 2, 2011
The Trainings page of the ForwardHealth Portal at www.forwardhealth.wi.gov/ includes information about current ForwardHealth training opportunities, such as covered topics, dates, times, locations (if applicable), online registration, and related training materials.

No. 2011-80: New Procedure Codes for Mileage for Transports by Ambulance Providers
December 2, 2011
Effective for dates of service on and after July 1, 2011, procedures for billing ForwardHealth for mileage for transport by ambulance providers for BadgerCare Plus and Wisconsin Medicaid members have changed.

No. 2011-79: New Prior Authorization Criteria for Wearable Cardioverter Defibrillator
November 22, 2011
This ForwardHealth Update describes new prior authorization (PA) approval criteria for the rental of a wearable cardioverter defibrillator (WCD) effective for PA requests received on and after December 1, 2011.

No. 2011-78: Clarification of Provider Responsibilities for Requesting and Amending Prior Authorizations for Synagis^®
November 22, 2011
As a reminder, prior authorization (PA) is required for Synagis®. Prior authorization requests for Synagis® may be submitted via the Drug Authorization and Policy Override (DAPO) Center at (800) 946-9627, the ForwardHealth Portal, or by paper.

No. 2011-77: Changes to Reimbursement for Exceptional Supplies for Nursing Home Residents
November 22, 2011
Effective for dates of service (DOS) on and after January 1, 2012, exceptional supply reimbursement for nursing home residents who are ventilator dependent for life support or residents who have a tracheostomy will no longer be considered for prior authorization (PA).

No. 2011-76: Reminder: Claims for Outpatient Hospital Therapy Services Must Be Submitted Using a Professional Claim
November 22, 2011
Providers of outpatient hospital physical therapy (PT), occupational therapy (OT), and speech and language pathology (SLP) services are reminded to submit claims using a professional claim to receive reimbursement. Effective for claims processed on and after January 1, 2012, ForwardHealth will deny claims for outpatient hospital PT, OT, and SLP services submitted using an institutional claim.
Providers of outpatient hospital physical therapy (PT), occupational therapy (OT), and speech and language pathology (SLP) services are reminded to submit claims using an 837 Health Care Claim: Professional transaction or a 1500 Health Insurance Claim Form to receive reimbursement.

No. 2011-75: Hospital and Ambulatory Surgical Center Access Payments Discontinued for Fiscal Year 2011
November 17, 2011
The Department of Health Services is discontinuing hospital and ambulatory surgical center (ASC) access payments for inpatient hospital, outpatient hospital, and ASC claims received and processed on and after November 18, 2011, for dates of service between July 1, 2010, and June 30, 2011.
Access payments for inpatient hospital, outpatient hospital, and ASC services for DOS on and after July 1, 2011, are not affected by this suspension.

No. 2011-74: Cost Sharing Clarification for Medicaid, BadgerCare Plus Standard Plan, and BadgerCare Plus Benchmark Plan
November 2, 2011
This ForwardHealth Update provides a guide to cost sharing for services covered by Wisconsin Medicaid, the BadgerCare Plus Standard Plan, and the BadgerCare Plus Benchmark Plan. Providers should always check Wisconsin’s Enrollment Verification System (EVS) to determine if a member is exempt from copayment.

No. 2011-73: Cost Share Exemptions for Tribal Members
November 2, 2011
Effective for dates of service on and after July 1, 2009, members identified as part of a federally recognized tribe are exempt from the cost share requirements for covered services when provided by a tribal health center or a tribal contracted entity.

No. 2011-72: Implementation of the HIPAA Accredited Standards Committee X12 Version 5010 Electronic 278 Health Care Services Review — Request for Review and Response Transaction
November 7, 2011
Beginning January 1, 2012, providers will have the ability to request prior authorization (PA) electronically using the 278 Health Care Services Review — Request for Review and Response (278) transaction, which is new to ForwardHealth with the implementation of Health Insurance Portability and Accountability Act of 1996 (HIPAA) Accredited Standards Committee (ASC) X12 version 5010 standards.

No. 2011-71: Prescription No Longer Required to Initiate Certain Mental Health and Substance Abuse Treatment Services
November 4, 2011
To conform with provisions of the 2009 Wisconsin biennial budget act (2009 Wisconsin Act 28), Wisconsin Medicaid and BadgerCare Plus no longer require a prescription from a physician or other health care provider to initiate certain psychotherapy or substance abuse treatment services for a Wisconsin Medicaid or BadgerCare Plus member.

No. 2011-70: Hospice Reimbursement Rate Changes
November 1, 2011
Effective for dates of service on and after October 1, 2011, Wisconsin Medicaid and BadgerCare Plus hospice service reimbursement rates have changed. Nursing home room and board rates are not impacted by these hospice reimbursement rate changes.

Coalition Roundup

Click here for a list of upcoming coalition meetings.

The Chippewa County HealthWatch Coalition last met in November at the Chippewa County Courthouse. 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 presented on at risk children and related issues. The next coalition meeting isn't until January 10, 2012, but mark your calendars now! For more information about the Chippewa County HealthWatch Coalition, please contact Rose Marsh.

The Dane County HealthWatch Coalition met on Monday, December 5 at the Waisman Community Outreach Center in Madison. The coalition received an update on the income maintenance transition - county consortia - from Mike Wineke of Dane County Economic Services. Erin McBride of ABC for Health led a discussion of local and statewide trends to watch, including the recent changes to fair hearings. Finally, Theresa Fosbinder presented an update on Family Planning Only Services. Dane County HealthWatch members also enjoyed some treats as a reward for their outstanding efforts during the Thanksgiving food drive. For more information about Dane County HealthWatch, please contact Adam VanSpankeren.

The Eau Claire County HealthWatch Coalition will miss Pat Perkins, who served for years as co-chair. She has accepted a new position and will no longer be available to chair the coalition. Lou Kelsey will be faciliating this transitional period. Please note that the January meeting has been canceled. For more information on the Eau Claire County HealthWatch Coalition, please contact Lou Kelsey.

The Milwaukee HealthWatch Coalition met yesterday, December 14 at Aurora Family Service. Lee Carroll, Executive Director of the Outreach Community Health Centers - formerly Health Care for the Homeless - came and spoke to the group about Outreach Community Health Centers clinics and services for low-income and homeless individuals, with a particular emphasis on mental health. Dr. Meghan Pesko and Adam VanSpankeren of ABC for Health also presented on the topic of birth cost recovery and its connection to infant mortality in Wisconsin, encouraging those present who have encountered issues with Birth Cost Recovery to get in touch with Adam VanSpankeren. Milwaukee HealthWatch will likely be moving to bimonthly meetings for 2012. In the months that the group does not meet, coalition members will still be able to share information to keep up with program and policy changes. If you would like more information on Milwaukee HealthWatch, please contact Julie Dixon-Seidl or (414) 773-4646.

The Pierce County HealthWatch Coalition next meets on January 19 at the Crossroads Community Church in Ellsworth, when a panel of service providers from the area will be presenting on a number of topics and initiatives, from homelessness to mental health to combating hunger. To RSVP for that meeting or for more information about the Pierce County HealthWatch Coalition, please contact Lisa Raethke.

The Tri-County HealthWatch Coalition meets next on Tuesday, December 27 at the Goodwill Community Center in Menasha. The coalition will be making plans in the wake of the state's decision to cut Wisconsin Well Woman Program funding to Planned Parenthood. The coalition will be assessing its resources and determining a course for 2012. There may be some changes coming, but the coalition will definitely be continuing its efforts to improve access to care and coverage in the Tri-County. 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...

Our family will be traveling to spend the holiday with relatives. My daughter will be traveling with us, and I’m worried that she might need medical treatment while we are out of state. Will her Katie Beckett Medicaid cover anything outside of Wisconsin?

...Get a Good Answer!

Yes. Emergency visits to a hospital outside of Wisconsin are covered for family members covered by Medicaid (this includes Katie Beckett, SSI-Medicaid, and BadgerCare Plus). Some providers near the border of Wisconsin may already participate in the Wisconsin Medicaid program. The procedure in these situations would be similar to any emergencies that were treated at a hospital in Wisconsin.

Providers that are not already approved as Wisconsin Medicaid providers will need to follow this procedure:

• Explain to the provider that the client has Wisconsin Medicaid and that the provider should submit the bills to: WI Out of State Claims 6406 Bridge Rd. Madison, WI 53784

• The out-of-state provider will then receive a data sheet that they must fill out and send back to Wisconsin. The form can be found online.

• The out-of-state provider will then receive a temporary provider number.

IMPORTANT: Remember that if Medicaid pays the out-of-state provider in part and not for the entire bill, the provider cannot hold the patient/client responsible for the difference. With the exception of nominal co-pays for adults only, in most cases you should never be billed for Medicaid-covered services. Providers that bill Medicaid recipients are committing Medicaid fraud.

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.

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.

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.

April 26-27. Circles of Life Conference 2012: a statewide conference for the efamilies of children and youth with disabilities and the professionals who support htem. This year's conference will be at the Madison Marriott Hotel. Fore more information, click here.

Parent to Parent of Wisconsin's Support Parent Trainings are held periodically throughout the State.  Trainings are held in small group settings (8-15 participants).  Registration is required for all trainings. The next training will be held on Saturday, April 16, 2011 from 9:00 am to 3:30 pm at the Children’s Hospital of Wisconsin Corporate Center (999 North 92nd, Milwaukee, WI). Call or email to register: 715-361-2934 or Get-Connected@p2pwi.org

A Training Announcement for All CYSHCN Collaborators: Did you  miss today's training webcast? Remember you can still view it archived.

Have you had this thought, "I've talked to this family two times already, and I'm not sure what resources are appropriate for them;" or "I wonder if ABC for Health would be able to pick up where I left off on this issue." If either is the case, this web cast will help you answer both of those questions. It will also provide a review of some of the common referrals we are seeing, and given the uncertain future of BadgerCare and Medicaid in Wisconsin, help sort out some possible approaches for conversations that we will have with families in early 2012.

Click the "Referral Form" image at right to be directed to a printable version of the CYSHCN Client Referral Form! Use this handy tool with directing a family to ABC for Health for services.

This web cast training was selected by YOU! Thank you! Not able to join the live web cast? Don't worry, email Adam to get information on how to view the archived webcast. We hope that you can join us again in the future!

State & National News

HealthWatch Analysis and Comment

Showdown Between Wisconsin and the Feds

By March of 2011, as part of the infamous budget repair bill, the Walker Administration published a plan to possibly terminate 53,000 adults from BadgerCare Plus. However, the administration, through Secretary Smith, did not submit a waiver request to CMS until November 10, 2011. CMS normally takes 90 days just to conduct initial technical review of the waiver and then, under normal circumstances, a usually lengthy process of negation takes place. Here, the Walker Administration tried to amplify the situation and created a hostage situation with 53,000 people (and their health care) at stake. Creating a Catch-22 situation is not the way to do business with CMS and certainly not the way to treat low income people and families in Wisconsin. If CMS approves the waiver, almost 65,000 BadgerCare recipients including 29,000 children will lose coverage. Both options are untenable.

CMS also acknowledged that Wisconsin could go ahead with their plan to instantly pull coverage for people who receive a termination of eligibility notice. We can expect DHS officials to move forward with this plan. (Presently, people getting a denial notice will have coverage to the end of the month, providing an opportunity for review or appeal.) But what happens to these costs that the state saves by terminating coverage earlier?? Those expenses do not just vanish. The unpaid bills are absorbed into everyone else’s bill. The result is a massive cost shift and socialization of that medical debt that will increase everyone’s premiums. That is the problem with the Walker and Smith plan. They don’t realistically follow the money. CMS should stand firm against the Walker Administration request and not be bullied into a premature response. Wisconsin legislators should do the responsible thing and remove the termination notice for 53,000 childless adults from Wisconsin law as proposed by AB 339.

Big changes loom large. Regardless of what CMS or the Walker administration actually decides to do, we can expect changes and more expensive health care. People will lose coverage due to terminations of eligibility and more red tape. We can’t assume people will jump right into a complex and expensive private individual health plan market. That, too, is extremely unrealistic. People will simply go without the coverage and the care they need.

Headlines

Health-care Reform: What You Should Know
Michael Skindrud & Todd Cleary, Wisconsin Lawyer Magazine, December 2011
It is not yet clear whether the cuts will reduce the number of persons covered, reduce the services covered, or both. As a result, fewer Wisconsin residents will have Medicaid to help pay for their care. Uncompensated care will increase, particularly in the state’s hospital emergency rooms

Area hospital rates rose more slowly than national average
Guy Boulton, Milwaukee Journal Sentinel, Dec. 14, 2011
The study found that hospital rates for commercial health plans increased an average of 34% from 2003 through 2010, compared with a 57% increase in the hospital component of the Consumer Price Index.

2.5 million young adults gain coverage
Associated Press, Dec. 14, 2011
Earlier estimates of around 1 million young adults gaining health care coverage were well exceeded, with the latest assessment totalling 2.5 million. This is largely credited toward the Affordable Care Act's new dependent coverage provision, allowing young adults up to the age of 26 to remain under their parents' insurance.

State's Proposal Would Keep Programs Sustainable [Opinion]
Dennis Smith, Journal Sentinel, Dec. 13, 2011
"With our proposal, called a federal waiver, we intend to take back our ability to make the right decisions for our state's program so we can keep it sustainable for those who need it most, now and later." Smith provides a breakdown of the 65, 000 person estimated coverage cuts, saying concerns are misplaced. "Not being enrolled in Medicaid does not mean they will be uninsured, a critical distinction to make."

State Medicaid deadline should be moved back [Editorial]
Journal Sentinel, Dec. 13, 2011
"The state should not let thousands of people go without health insurance while [the waiver proposal] is sorted out. Walker and the Legislature should push for a change in law that modifies the deadline so federal officials have more time to consider the entire request."

Legislatively Speaking - A new definition of family [OP-ED]
Sen. Taylor, Milwaukee Courier, Dec. 10, 2011
The GOP members of the Joint Finance Committee, who comprise the majority, granted the Department of Health Services permission to submit to the federal Centers for Medicare & Medicaid Services the state’s request to change the state Medicaid program’s eligibility and income requirements. One of the most alarming changes to the eligibility requirements is the new method for calculating family income.

Press Release: Administration Continues to Undermine Access to Women's Health Care
Wisconsin's Alliance for Women's Health, Dec. 15, 2011
Without explanation, legislative oversight or written notice, DHS earlier this month communicated their intent to end the Wisconsin Well Woman program with Planned Parenthood of Wisconsin Parenthood effective December 31.

Medicaid waiver coming soon, with patient-protection rules [Florida]
Carol Gentry, Health News Florida, Dec. 14, 2011
This week, federal health officials are expected to give Florida an early Christmas present: an extension on a five-county Medicaid Pilot that requires patients to be enrolled in managed care.

Ryan unveils new Medicare plan that keeps traditional option
Craig Gilbert, Milwaukee Journal Sentinel, Dec. 14, 2011
The original Ryan proposal won the unanimous support of House Republicans, but its sweeping change to the long-standing structure of Medicare made many Republicans nervous about the issue's impact at the polls. Democrats have attacked it with gusto as the "end of Medicare as we know it."

Study: To Reduce Readmission, Reduce Hospitalization
Margot Sanger-Katz, National Journal, Dec. 14, 2011
If you want to keep patients from returning to the hospital, you should aim to keep them out in the first place, a new study suggests.

Pa.'s drop in Medicaid rolls stirs controversy
Dan Sapatkin, The Philadelphia Inquirer, Dec. 14, 2011
Since August, the Corbett administration has cut off more than 150,000 people - including 43,000 children - from medical assistance in a drive to save costs.

An Open Letter to Secretary Sebelius and President Obama regarding the Institute of Medicine’s recommendations on the Essential Benefits under the 2010 Health Reform Law
PNHP, December 2011
Physicians for a National Health Program protests the Institute of Medicine’s recommendation that cost rather than medical need be the basis for defining the “essential benefits” that insurance policies must cover when the federal health reform law takes effect in 2014.

New Federal Loan Program Helps Nonprofits Create Customer-driven Health Insurers
December 2011
The Affordable Care Act creates a program to help create new, private nonprofit health insurers, called Consumer Oriented and Operated Plans, or “CO-OPs.”  The CO-OP program offers low-interest loans to eligible private, nonprofit groups to help set up and maintain health plans.  CO-OPs are directed by their customers and designed to offer individuals and small businesses additional affordable, consumer-friendly and high-quality health insurance options.  Starting January 1, 2014, CO-OPs will be able to offer health plans through the new, competitive health care marketplaces in each State, called the Affordable Insurance Exchanges.  In addition to offering health plans through an Exchange, CO-OPs may also offer health plans outside of an Exchange.

CHIP Dental Coverage: An Examination of State Oral Health Benefit Changes as a Result of CHIPRA
National Maternal and Child Oral Health Policy Center, December 2011
Although states struggle with low utilization of dental services by children enrolled in public programs, since the passage of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), all children in the Children’s Health Insurance Program (CHIP) will have a base level of dental coverage included in their benefit package.

Opposition to 2011 Senate Bill 306
Wisconsin Medical Society, Dec. 13, 2011
The Society objects to criminalizing a physician’s decision on how to practice medicine when those decisions concern a legal procedure and are in compliance with what are appropriate protocols for the standard of care.

Milwaukee police to pay more for health care in exchange for raise
Journal Sentinel, Dec. 13, 2011
The Milwaukee Police Association deal would bring slightly larger raises for some 1,700 rank-and-file police officers and detectives than previous agreements gave police commanders and firefighters.
But city negotiators achieved a key goal by requiring the officers and investigators to pay 12% of their health care premiums, the same proportion all other city employees must pay under the new state law and the other public safety union contracts, City Labor Negotiator Troy Hamblin said.

Delay in Medicaid changes approval may cut coverage for 53,000
Wisconsin State Journal, Dec. 9, 2011
On Nov. 10, the state asked CMS to approve key parts of its plan to trim $554 million over two years from Medicaid, the state-federal health plan for the poor.
This year's state budget law said lack of approval by Dec. 31 would require ending BadgerCare Plus coverage in July for 53,000 adults who earn more than a third above the federal poverty level. That's about $30,000 a year for a family of four.
Approval of the state's proposals, meanwhile, would cause nearly 65,000 people to leave or be turned away from BadgerCare Plus and other Medicaid programs, the nonpartisan Legislative Fiscal Bureau said. That's mostly because of higher premiums, a required switch to employer insurance and changes in eligibility.

Walker administration applies for SeniorCare extension
Dec. 8, 2011
Governor Walker authorized the Secretary of the Department of Health Services (DHS),
Dennis Smith, to request a federal extension on Wisconsin’s SeniorCare waiver. The current waiver is slated to expire on December 31, 2012. See the letter from DHS to CMS.

GOP stonewalls health care reform in Wisconsin
Isthmus, Dec. 8, 2011
Walker administration officials in charge of putting the sweeping law into effect are openly hostile to the Patient Protection and Affordable Care Act, the formal name for the bill that Pres. Barack Obama signed into law after a grinding, yearlong battle in Congress. GOP legislators and the party's base are just as opposed.

Wisconsin improves in health survey
Journal Sentinel, Dec. 6, 2011
Wisconsin rose to 13th in an annual ranking of overall health in a year when the nation's health showed no improvement.

Feds crack down on FoodShare fraud on social media
Journal Sentinel, Dec. 6, 2011
Federal officials unveiled new rules Tuesday to crack down on fraud in public food benefits, including targeting illegal sales on social media sites and investigating recipients who report their cards lost repeatedly.

The bomb buried in Obamacare explodes today - Hallelujah!
Forbes, Dec. 2, 2011
"[Medical loss ratio] is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time.  Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry."

50 Wisconsin Organizations Unite to Call Upon Federal Government to Reject DHS Waiver
Save BadgerCare Coalition, Dec. 1, 2011
In an effort to prevent more than 64,000 Wisconsinites from losing their BadgerCare coverage, 50 organizations from throughout Wisconsin, call on U.S. Health and Human Services (HHS) Secretary Sebelius to deny the recent request from the Wisconsin Department of Health Services (DHS) for a waiver of federal maintenance of effort (MOE) requirements.

Vermont gets 18 million for health exchange
PNHP, Dec. 1, 2011
The U.S. Department of Health and Human Services announced on Tuesday Vermont will receive more than $18 million to fund the design and development of a larger health benefits exchange to serve as the foundation for the state's future single-payer plan.

Despite Economic Challenges, Progress Continues: Children’s Health Insurance Coverage in the United States from 2008-2010
Center for Children and Families, Nov. 29, 2011
Even though the number of children living in poverty has increased almost 19 percent over a three-year period, the number of children without health insurance declined 14 percent– a true bright spot in an otherwise challenging landscape for America’s children. In 2010, about 8 percent of children were uninsured, as Medicaid and CHIP filled the gap created by the loss of coverage from the private sector.

States receive more flexibility, resources to implement Affordable Insurance Exchanges
Nov.29, 2011
The Department of Health and Human Services (HHS) today awarded nearly $220 million in Affordable Insurance Exchange grants to 13 states to help them create Exchanges, giving these states more flexibility and resources to implement the Affordable Care Act.  The health care reform law gives states the freedom to design Affordable Insurance Exchanges – one-stop marketplaces where consumers can choose a private health insurance plan that fits their health needs and have the same kinds of insurance choices as members of Congress.
Also see: State Exchange Implementation Q&A

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Update Staff:
Bobby Peterson, Executive Director
Brynne McBride, Assistant Director
Adam VanSpankeren, Education and Outreach Coordinator
Evan Benner, Publications Assistant