Public Policy Council Gets Medicaid Budget Overview from State

Council also opposes new stroke care mandates

December 04, 2018

At the November 29 WHA Council on Public Policy meeting, Legislative Fiscal Bureau (LFB) staff Charlie Morgan and Jon Dyck provided information about the State Medicaid budget, the potential for Medicaid expansion, and updates on the waiver to provide Medicaid coverage for childless adults.

Their highlights included:

  • The current annual Medicaid budget is $9.5 billion;
  • Medicaid is the second largest expense of taxpayer dollars (after school aids);
  • Long-term care is a significant driver of Medicaid costs at $3.6 billion/year; and,
  • Elderly/Blind/Disabled represent 22% of enrollees, but 60% of program costs.

The LFB also discussed the potential impacts of a full Medicaid expansion, covering all adults up to 138% of the federal poverty level (FPL). The estimated expansion savings for the next state budget are $280 million, anticipating a January 1, 2020 implementation. The LFB also estimated that Medicaid enrollment would increase by 75,000 lives under a full expansion scenario.

WHA President and CEO Eric Borgerding noted that it is clear Governor-elect Evers will put Medicaid expansion on the table.

“If Wisconsin is going to expand Medicaid, it is incumbent upon the State to reinvest those new dollars into health care. Wisconsin today, with its current Medicaid population, already shifts over $1 billion in unpaid Medicaid costs to Wisconsin’s commercially insured employers and families,” Borgerding said. “We have absolutely critical needs in our health care workforce that could benefit from greater state support. Bottom line is health care funds should fund health care. Medicaid dollars aren’t a cookie jar to fund everything other than health care.”

On October 31, the Centers for Medicare & Medicaid Services approved the State’s “1115” waiver to continue Medicaid coverage for childless adults up to 100% FPL. LFB highlighted the following provisions that were included in the approved waiver:

  • 48-month limit on benefits
  • Work requirements
  • Premiums
  • Copayments for non-emergent emergency room use
  • Healthy behavior incentives
  • Exception to the Institutes for Mental Disease (IMD) exclusion for substance abuse treatment

The Department of Health Services has indicated implementation will take at least one year. Legislators have expressed an interest in codifying key elements of the waiver to ensure implementation under the new administration of Governor Evers. WHA joined 32 other Wisconsin health care organizations in a letter to state lawmakers expressing significant concerns with legislation fast tracked for the lame-duck session. (See related article.)

Stroke Care Improvement in Wisconsin
WHA’s Chief Quality Officer Beth Dibbert and Vice President of Workforce Development and Clinical Practice Ann Zenk updated the Public Policy Council about stroke care legislation that is rumored to be presented by the American Heart/American Stroke Association.

As the information was shared with WHA, the mandates would require all Wisconsin EMS services to submit stroke care protocols to the State for approval. The protocols may include instances where EMS would bypass local hospital emergency departments to transport the patient to a hospital with stroke certification. The other mandate would require the state of Wisconsin to publicly report a list of all hospitals in Wisconsin that are certified for stroke care. Dibbert and Zenk gave a brief history of stroke care improvement in Wisconsin, including WHA’s active participation in statewide advisory committees and improvement collaboratives.

Public Policy Council members reacted to the proposed mandates, mostly questioning the need for legislation now when the state is mid-way into a multimillion dollar grant, and Wisconsin’s stroke mortality ranking is currently better than many other states who have allowed this model legislation to pass.

“There are other health issues that present as a stroke, and we want our EMS personnel to get patients to a hospital as fast as possible so a neurologist can make that decision,” said Michael Decker, CEO of Divine Savior Healthcare. “We do not want EMS out of service or losing precious time because they are bypassing local hospital EDs to drive a patient further when that patient could be receiving immediate care and diagnosis.”

This story originally appeared in the December 04, 2018 edition of WHA Newsletter