Wisconsin Medicaid Director Briefs WHA Public Policy Council

March 31, 2017

Wisconsin Medicaid Director Michael Heifetz told members of the WHA Council on Public Policy at their March 30 meeting in Madison that Gov. Scott Walker actively advocated for the "Wisconsin Model" of Medicaid expansion during the debate on the American Health Care Act (AHCA).

"Wisconsin is the only state with 100 percent coverage for those in poverty, according to Kaiser, and we are a high-quality state," according to Heifetz. The Governor, he said, is very proud of the Wisconsin Model, one the hospitals and health systems "helped build and sustain," according to Heifetz.

"We have a great story to tell," said Heifetz, regarding Wisconsin’s high-quality health care. Heifetz said the Governor was advocating within the debate on the AHCA to reward those states that provide high-quality and accessible health care to their residents.

At the state level, Heifetz said the Medicaid program is fully funded, with some additions that were "overdue" and that are also beneficial to Wisconsin’s hospitals and health systems. These included mental health reforms, increases in nursing home reimbursement and initiatives focused on opioid abuse.

Heifetz discussed a Medicaid demonstration waiver the state will be pursuing, which includes premiums for some Medicaid enrollees, co-pays for use of hospital emergency departments and drug screening for individuals applying for Medicaid. Members of the Council expressed concerns with several provisions mentioned as part of the waiver, specifically concerns with co-pay requirements for hospital emergency department utilization. Heifetz said the waiver application is in the "early stages," and interested stakeholders will have an opportunity to provide input regarding the waiver’s provisions.

"This is an open process. The Governor’s goal is not to dis-enroll people," Heifetz said. "Rather he wants to reward work and not make public programs a hammock, but rather, a trampoline."

American Health Care Act – what’s next?
Joanne Alig, WHA senior vice president, policy & research, reviewed the fluid process and the policy of the American Health Care Act (AHCA). Alig said there is still uncertainty about the timing of any legislation, and while there had been reports of talks continuing in Washington, it is anyone’s guess as to whether a new vote will be scheduled on a bill this spring.

Alig described WHA’s position and advocacy, noting that under the ACA, Wisconsin experienced a 38 percent decline in the uninsured rate. That, coupled with reductions in uncompensated care have been positive for Wisconsin. Although Medicaid and Medicare shortfalls increased during the same time, more than 195,000 people gained coverage from 2013 through 2015 in Wisconsin. Further, WHA has advocated any bill that includes changes to Medicaid financing must ensure equity among expansion and non-expansion states.

In terms of equity, Wisconsin expanded coverage to childless adults without receiving higher federal funding like many other states. At the same time, Wisconsin reduced Medicaid eligibility for about 60,000 adults in 2014, relying on income-based subsidies being available for low income Wisconsinites to obtain private coverage.

Under the AHCA, Wisconsin could have received an estimated $70 million in "safety net" funding. But under Wisconsin’s Model for coverage, Wisconsin is spending about $280 million in state dollars for a population group for which other states get full federal funding. In short, the bill continued to create inequities for states like Wisconsin because it still did not recognize Wisconsin’s coverage expansion as a "full expansion."

WHA will continue to assess the developments in Washington and in Madison to help shape the path to come. For example, WHA will be analyzing various aspects of Medicaid expansion and will continue to assess if there are any other regulatory or administrative actions that could help provide equity for states.

Council members identified several concerns with the AHCA as it was structured, including that the level of the tax credits would be insufficient to ensure affordable coverage for low income Wisconsinites. Wisconsin relied on the income-based subsidies available under the ACA to ensure access to coverage. Council members also questioned the long-term viability of the insurance exchanges and discussed what options the federal government might have to help stabilize the markets through regulations. Finally, members noted that we must be diligent to maintain Wisconsin’s high-quality health care and the significant investments hospitals and health systems have made to integration and value.

Wisconsin State Budget & 2017-18 Legislative Session
Kyle O’Brien, WHA senior vice president, government relations, briefed the Council on the Governor’s proposed state budget and work the Association is doing to advocate for additional investments in the state Medicaid program through the legislative process. O’Brien provided an update on the Association’s advocacy work, including testimony being prepared for the Joint Finance Committee’s statewide public hearings that asks the Committee to use a portion of the $300 million lapse from the Medicaid program to fund several WHA budget priorities.

O’Brien reported WHA is working to increase the Medicaid Disproportionate Share Hospital (DSH) program, fund elements of the Rural Wisconsin Initiative related to health care, provide additional resources for outpatient mental health care and create a payment methodology for provider care coordination for the state’s Medicaid program.

Alig discussed what WHA knows about the Department’s Medicaid waiver request requiring premiums for able-bodied adults on the Medicaid program, along with additional co-pays and drug screening requirements for Medicaid enrollees. Alig said WHA would review the requirements once official documentation is made public and will comment to both the Walker Administration and members of the legislature regarding the impact of these provisions on Wisconsin’s hospitals.

Along with the budget, O’Brien said WHA is working alongside a coalition of providers to advocate for Assembly Bill 146—legislation that allows dental hygienists to practice in additional settings without supervision by a dentist. The legislation passed the Assembly Health Committee March 29 with unanimous support from the Committee. WHA expects the legislation will be approved by the full Assembly next week.

Matthew Stanford, WHA general counsel, provided the Council with several additional updates regarding legislation to reform Wisconsin’s emergency detention process, a proposed revision to Medicaid’s telemedicine regulation and updates regarding the Wisconsin Prescription Drug Monitoring Program (PDMP) and a state mandate for prescribers to check the PDMP that begins April 1, 2017.

Wisconsin Hospitals State PAC & Conduit Update
Jenny Boese, WHA vice president, federal affairs & advocacy, and Nora Statsick, WHA political consultant, provided the Council with an overview of the Wisconsin Hospitals State PAC & Conduit’s recording-breaking 2016 year. In total, the campaign raised over $305,500, a 12.5 percent increase over the previous year. In 2016, 353 individuals contributed, on average, $863 each. All total in 2016, the political funds disbursed over $350,000, setting another record. For 2017, the fundraising goal is to raise $312,500. The campaign is off to a good start with over $71,000 contributed by 72 contributors. The Wisconsin Hospitals State PAC & Conduit will also host a kick-off breakfast immediately prior to the start of WHA Advocacy Day on April 19 for individuals who have contributed $250 or greater.

This story originally appeared in the March 31, 2017 edition of WHA Newsletter