Not only does the budget make $467 million in unspecified cuts to BadgerCare, but it establishes a new process for making fundamental policy changes that provides little to no legislative or public input. The bill includes a sweeping and unprecedented shift in decision-making authority from the Legislature to unelected officials in the Department of Health Services (DHS).
DHS will use this new authority to achieve the level of savings dictated by the deep cut to Medicaid and BadgerCare funding in the budget. This $467 million in cuts could jeopardize health care coverage for many of the more than 1 million state residents who depend on these programs for their insurance and quality of life.Act 10 (the budget repair bill) gave DHS the power to change Medicaid and BadgerCare policy—even superseding existing law— through a rule-making process that including opportunities for legislative and public input. The biennial budget bill repeals all of the Medicaid language in Act 10 and incorporates nearly all of it in the budget. However, it removes the rule-making provisions, thereby eliminating the only requirement for public hearings on fundamental policy changes relating to Medicaid and BadgerCare.
The amended bill added language requiring DHS to submit policy changes to the Joint Finance Committee if those changes would conflict with state statutes. That change provides a small degree of legislative oversight, but most legislators will be absolved of any responsibility for policy decisions that may substantially rewrite current law.
Rewriting current law will be necessary to make the $467 million in “unspecified” cuts to Medicaid. Though these cuts aren’t itemized in the budget, DHS has provided a general description of the types of program changes they intend to pursue. These changes may include increased cost sharing, limiting benefits, mandating that program benefit recipients enroll in managed care, restricting or eliminating presumptive eligibility, imposing restrictions on benefits for non-citizens, and reducing income eligibility ceilings.
The budget requires DHS to request a federal waiver exempting the state from current federal maintenance of eligibility requirements. If a waiver is not received by December 31, 2011, income eligibility for adults will be reduced to 133% of the federal poverty level, ending insurance coverage for 60,000 Wisconsin adults. For a more thorough analysis of the possible changes and power shift, see WCCF’s recent paper.
“Wisconsin has long been a leader in ensuring that nearly everybody in the state has health insurance coverage,” said Ken Taylor, executive director of the Wisconsin Council on Children and Families. “With this budget, we’re at risk of taking steps backwards right when we were the closest we’ve ever been to finishing the job of covering everybody.”
WCCF encourages DHS to provide multiple opportunities for public input on proposed policy changes, including all waiver requests. Concentrated efforts to work towards transparency and accountability are necessary to achieve Medicaid savings without harming beneficiaries or merely shifting costs.
Sara Eskrich
Tomorrow—Way #3: Using Federal Welfare Reform Funds for Other Purposes, Such as Tax Cuts
About the series: “31 Ways in 31 Days” is a series of posts to the WCCF blog exploring the recently-passed biennial budget’s impact on children and families in Wisconsin. Each day in July, we are posting a description of one way the budget will affect kids and families, with an eye toward what should be done going forward to help improve outcomes and move us closer to the goal of making Wisconsin a place where every child has the opportunity to grow up, learn, and thrive in a safe, healthy, economically secure home and community.
