Jacobson Joins Health Care Leaders to Discuss Medicaid, ACA, Health Reform

Rakowski on Medicaid program: “Providers are pulling more than their fair share”

May 05, 2017

Changes to the Medicaid program “won’t be easy,” but Department of Health Services Secretary Linda Seemeyer said implementing nominal premiums, drug testing and other elements included in Wisconsin’s childless adults waiver will give recipients “a little skin in the game.”

Speaking at a luncheon sponsored by the Public Policy Forum, Inc. in Milwaukee May 3, Seemeyer said the 48-month limit on Medicaid eligibility for childless adults has been among the most controversial aspects of the waiver. However, she emphasized that if the person is working or is training for a job, they would not lose their Medicaid coverage. Seemeyer cited a Marquette poll that found 79 percent of the people who participated generally did not view a work requirement negatively. 

Following Seemeyer, Forum President Rob Henken moderated a panel discussion on the ACA and the implications health reform could have on patients, providers and payers in metro Milwaukee. The panelists included: Catherine Jacobson, CEO, Froedtert Health and WHA Board Chair; Bevan Baker, commissioner, City of Milwaukee Health Department; Mark Rakowski, vice president, Children’s Community Health Plan; and, Julie Schuller, MD, president/CEO, Sixteenth Street Community Health Centers. 

The ACA was not about cost, but was about coverage, and Jacobson said that was a “phenomenal benefit” across the state. Both Baker and Jacobson emphasized the importance of helping people access the right care at the right time in the right place and in addressing the social determinants of health that are often barriers to getting that care. 

Jacobson noted though that before we can get to the social determinants, and “before you can have access to care, you must first have coverage.” 

She added that federal health reform efforts must recognize and reward Wisconsin’s model for Medicaid expansion. About 130,000 more childless adults with income below poverty now have Medicaid coverage, and about 240,000 people in Wisconsin signed up for coverage in the insurance exchange in 2017. 

On the Medicaid waiver, Jacobson and Schuller shared their concerns about the impact of eligibility changes. Schuller said even very small changes in program requirements and payments can have very large impacts on the population they serve.

Jacobson said WHA has spent a lot of time reviewing the impact of the waiver, and she emphasized that as a health care leader and employer she fully understands the goal to engage patients in the cost of their care and in their overall health. For the Medicaid population, however, she remains concerned about the significant ramifications of not paying a small premium—losing coverage. They will still need care and will seek it in the emergency room. She also expressed the concern of the ramifications to providers of uncollected co-payments, which will simply resolve as a reimbursement cut to providers. 

Related to the requirement for drug screening and testing, Baker noted the significant time and resources that are pouring into the opioid epidemic. He is concerned hurdles are being put in place for people with drug addiction to stay on Medicaid and get the care they need. 

From the Medicaid managed care perspective, Rakowski described the significant participation by health plans, with 15 health plans participating in managed care plans in Wisconsin, as being far different from other states. He added the strength in southeast Wisconsin is on the provider side—all the health systems and FQHCs participate in Medicaid. While there is not much money for providers in the program, “there is a commitment to that population.”

“Providers are pulling more than their fair share on this,” Rakowski said. “We also have a really strong relationship with the Department of Health Services…and we have 700,000 individuals in the BadgerCare program and our outcomes continue to improve every year.”

Rakowski said unlike insurers in other states, the provider-sponsored health plans in Wisconsin are staying in the exchange. While the exchanges are not a “profit center,” it is a way for their patients and their families to access affordable health care. 

Jacobson said Wisconsin started in a better place on premium rates, not that rates have not increased, but the provider-sponsored plans can balance that, take some losses and provide coverage with their members. “That is the heart of Wisconsin’s success,” Jacobson said.

Sixteenth Street Clinic is on the frontlines of caring for the “poorest of the poor.” Schuller said Milwaukee has made great strides over the past five to ten years in the health care system as a whole in leveraging the strengths of the system. 

The community health care centers fill in the gaps, and Schuller said they are very appreciative of the help they receive from health care systems and Medicaid HMOs, but “it is a fragile system.” 

All of the panelists voiced concerns about workforce shortages. Jacobson said the aging of the population in Wisconsin is significant for what it will mean for health care needs and workforce needs. 

In addition to workforce, panelists also seemed to agree on the need to address health care costs in the long term, particularly the need for more resources for prevention and care management up front as a way to address long-term health care costs. 

Link to Milwaukee Public Policy Forum: www.wiseye.org/Video-Archive/Event-Detail/evhdid/11508

This story originally appeared in the May 05, 2017 edition of WHA Newsletter