As the incoming Trump Administration prepares to take office and many speculate about federal health care reform, Wisconsin officials are anticipating more flexibility in the Medicaid program and aren’t waiting to set down their own policy ideas related to the Medicaid program.
In December, Gov. Scott Walker sent a letter to President-elect Donald Trump outlining principles for more limited and controlled federal involvement in states and asking for help in implementing some policies in a number of areas that have previously been denied by the federal government. Related to Medicaid, Walker asks Trump for approval to implement differential premiums for childless adults “who purposefully increase their health risks while receiving benefits.” His idea is just one of a handful of provisions that were included in the state biennial budget in 2015. The language enacted in 2015 Wisconsin Act 55 calls for the state to seek a waiver from the federal government for this and other policies such as drug screening and testing and limiting eligibility to no more than 48 months. Under the Obama administration such policies were not approved.
Subsequently, on January 5, a group of 34 Republican state senators and representatives from across Wisconsin signed onto a letter to Walker requesting changes to public assistance programs and citing the recent election as an opportunity for more state flexibility. Specifically, these legislators seek to allow for a “sliding scale” in public benefits so benefits start to decrease as income rises. Without such a sliding scale, these legislators are concerned that individuals receiving public benefits hit a “fiscal cliff” and may turn down jobs, promotions and raises out of fear of losing their child care, food or health benefits. The letter calls for state agencies to review which programs have “fiscal cliffs” and request waivers to create and implement sliding scales. The exact structure of such a sliding scale for the Medicaid program was not included in the letter.
At a panel discussion sponsored by Wisconsin Health News January 10, WHA President/CEO Eric Borgerding said block grants could make sense on the surface, especially in states like Wisconsin where we have led the way in so many things, however, he believes the devil is in the details and he urged lawmakers to carefully consider the impact that changes in eligibility could have on Medicaid recipients to have access to care.
“There are a lot of things states can do with their Medicaid populations when they are given flexibility related to cost sharing. In the past, there were cost-sharing arrangements tried with populations that had eligibility criteria well above 100 percent FPL,” Borgerding said. “So as we talk about copays, premiums and those sort of things through a waiver or block grant process, while it may make a lot of sense to encourage people to have skin in the game, even in the Medicaid population, we cannot lose sight of the fact that in Wisconsin, Medicaid applies to those in poverty and that is below $11,700 per year. We have to be very cautious when we talk about what that means for that population either staying enrolled in Medicaid or having access to the services they need.”
The letter from Governor Walker to President-elect Trump can be found here: /WisconsinHospitalAssociation/media/WHANewsLetters/2017PDF/WalkerLetterTrump12-20-16.pdf
The letter from Republican Legislators to Governor Walker can be found here: /WisconsinHospitalAssociation/media/WHANewsLetters/2017PDF/darlingletterwalker1-5-17.pdf