Governor’s Proposed Budget Expands Access to Health Care and Helps Reduce Racial Disparities

Introduction

No matter where we live or what we look like, we all deserve to live safe and healthy lives. We all need access to quality, affordable health care that supports our wellness. However, over decades, Wisconsin lawmakers have chosen the wealthy few over the health and wellbeing of all families. By failing to invest in the social determinants of health, Wisconsin families face unprecedented disparities in education, income, housing and more. Providing better care for people, especially those experiencing health disparities or with the most need, results in a stronger, better system with far reaching social and community benefits for everyone.

But, any state-level improvements and investments will be much harder to achieve if Congress slashes Medicaid funds, as they’ve taken steps to do.

Wisconsin’s Budget, especially health care, is built on federal Medicaid dollars

Medicaid funds account for more than one out of every four dollars that make up the state’s nearly $50 billion budget. Governor Evers proposed a budget for health care that would help address maternal and child health disparities, remove lead from our schools, child care centers, and homes, expand access to health care, reduce out of pocket costs for consumers, and raise rates that Medicaid-funded providers receive. All of that depends on strong and stable federal Medicaid funds. However, Congress is trying to cut at least $880 billion from Medicaid, the nation’s health insurance and long-term care safety net. This would be disastrous for Wisconsin’s children and families – including the one in three rural kids who depend on Medicaid for their health coverage.

How does the Governor’s proposed budget address this?

Prioritizing maternal health and taking steps to address racial disparities

Black women are significantly more likely to die due to pregnancy-related causes than white women. This disparity is even more egregious in Wisconsin, where Black women are five times more likely to die due to pregnancy-related causes than white women. This disparity persists regardless of income or education.

The Governor’s budget includes:

• Providing about $23 million over the biennium to extend postpartum coverage for 12 months for those enrolled in BadgerCare. Extending postpartum coverage for one year is widely supported by lawmakers on both sides of the aisle, and would begin to address our state’s stark maternal mortality crisis by helping to ensure continuity of care for parents and infants. To date, Wisconsin is one of only two states in the US that have failed to extend postpartum coverage. The other is Arkansas.
  Unfortunately, the proposed extension leaves out people who are ineligible for BadgerCare due to their immigration status or because they’re in prison or jail. The BadgerCare Prenatal program can cover pregnant people who are ineligible for these reasons, but that coverage ends on the last day of the month their pregnancy ends.
• Allowing Medicaid to reimburse providers for doula services. Doulas are part of a holistic care team. Working with doctors, nurses, and families to offer advice, information, physical and emotional support, and advocacy for birthing people and their partners before, during, and after birth. Research shows that doulas improve health outcomes.
• Increasing grant funds that support women’s health, more than $8 million in funds for local health departments and other entities to better coordinate maternal and child health activities and improve maternal child health
• Increasing Medicaid reimbursement rates for obstetrics care and providing diapers to families in need.
• Ending the misguided practice of birth cost recovery, so resources aren’t drained from needy families just because parents aren’t married.

Expanding BadgerCare and reinvesting savings back into the Medicaid budget

Governor Evers’ proposed budget expands BadgerCare eligibility to 138% of the federal poverty level, which is about $21,600 a year for a single parent with one child. About 96,000 adults (nearly two thirds of which are parents) are expected to gain coverage, and the Department of Health Services (DHS) estimates the state would save about $1.9 billion over the course of the two-year budget and more than $200 million a year thereafter. The budget puts those dollars back into the Medicaid program to leverage even more federal funds and invests those in vital services such as hospitals and rural health care providers, as well as increasing some Medicaid reimbursement rates.

Wisconsin is one of the few states that has not expanded Medicaid, and Wisconsin is the only state that is consistently spending more state dollars to cover fewer people.

Lead service lines and increasing access to treatment

Once again, the Governor’s proposed budget would expand access to treatment for children exposed to high lead levels. The rate of children with lead poisoning in Wisconsin is worse than the national average. Due to structural and economic barriers to health, Black children are more likely to have elevated blood-lead levels than other children in our state. The Governor’s budget decreases the blood-lead level children must have to receive treatment. This makes more children eligible for treatment of lead exposure, and funding is increased to meet that projected demand.

The budget includes $200 million GPR to replace lead service lines and restarts the Windows Plus program, which helps people address lead remediation in their homes, schools, and child care centers to prevent children’s exposure to lead. Finally the budget allocates about $6 million GPR to local health departments to investigate instances of children’s exposure to lead.

Medicaid reimbursement for care provided by community-focused providers

The Governor proposes to expand the types of services that Medicaid providers will be paid for and allocates several million dollars over the biennium to support those increases in services. Under the proposed budget, Medicaid benefits would be expanded to cover support from doulas, community health workers, and peer specialists. Numerous studies have demonstrated the positive impact that these services can have on people’s maternal health, mental health, and overall health outcomes – notably people of color, rural communities, and those more likely to be impacted by health disparities.

Investing in health care for children with complex care needs

The Governor’s budget proposes to change the way the Children’s Long Term Support Program is funded so that it can expand and contract to meet the needs of kids and parents. CLTS is a Medicaid-funded program that helps children with disabilities and their families meet their growing health, daily living, and wellness needs so they can live in their homes. The budget also proposes increasing Medicaid reimbursement rates for services to children with autism spectrum diagnosis.

Reducing out of pocket costs associated with health care and prescription drugs

Sales taxes are a building block for state and local budgets. However, they are also one of the most unfair taxes. They fall more heavily on taxpayers in lower income households who have to spend a larger share of their earnings on health-related essentials than the wealthy. The Governor’s budget proposes to help reduce costs on some of these essentials for working families. The budget proposes to exempt retail sales tax for:

• Diapers
• Breastfeeding Equipment
• Feminine Hygiene and Adult Incontinence Products
• Over-the-Counter Medications

The Governor’s budget also seeks to reduce the cost of prescription drugs and ensure that any cost savings associated with medication discounts and coupons are passed on to consumers rather than having middlemen swallow up the savings. The budget would cap insulin costs at $35 per month for all health insurance plans in Wisconsin. The budget forms a prescription drug review board, which would analyze other state and national drug pricing schemes and policies, and set price limits on drugs when necessary to limit predatory cost increases. The Governor seeks to create an office of Prescription Drug Affordability to administer efforts and work to further reduce the cost of prescription drugs for Wisconsin residents.

Funding for Essential Health Care Facilities

To increase access to health care for Wisconsinites throughout the state, regardless of whether they are covered through Medicaid, employer-sponsored insurance, the ACA, or are uninsured, the governor’s budget proposes increasing support for federally qualified health centers by $11.5 million over two years. Community Health Centers are critical providers of primary care, dental, behavioral health, and other services that keep families healthy. The governor also recommends $15 million reserved for hospital services in western Wisconsin where two hospitals have closed their doors. Lastly, the budget recommends increases in Medicaid reimbursement for rural health care clinics and $500,000 over the biennium to support free and charitable clinics.

Improving private health insurance and increasing health insurance access

The proposed budget takes steps to improve coverage for people with private health insurance. It would limit the practice of surprise or balance billing where patients have little control over their health care choices, such as emergency situations. It would also limit insurance companies from requiring prior authorization for inpatient mental health services. The budget would require plans to cover more health care services, create more transparency for consumers, and audit health insurers that have high claims denial rates.

The Governor’s budget would connect more people with health coverage by implementing Easy Enrollment in Wisconsin. This allows someone who is uninsured to check a box on their state tax return indicating that they’re interested in getting coverage either through
BadgerCare or the Healthcare.gov Marketplace. Despite coverage gains from the Affordable Care Act, Wisconsin still has stark racial disparities in insurance coverage. Black, Indigenous, and Latine residents in Wisconsin are much more likely to be uninsured than their white counterparts.