The Department of Health Services (DHS) unveiled a new webpage Monday that contains descriptions of some of their Medicaid cost-cutting plans and provides an online mechanism for the public to submit comments on the department’s proposals. Thus far, most of the measures described there are the ones approved by the Legislature in the biennial budget bill, such as capping enrollment in the Family Care program. 

I have somewhat mixed feelings about the new DHS webpage. My quote in the AP article captures that: “I’m glad they’ve acknowledged that they’re interested in public comments, but it’s not a very meaningful gesture until we see the meat of their plans.”  That observation reflects a feeling of consternation that I think is shared by many other advocates who are anxious to see the DHS proposals and to ensure that BadgerCare and Medicaid participants have an opportunity to learn about the potential effects and to raise any concerns they may have.  My frustration stems from the following factors:

• The original emergency rationale for the Medicaid power shift – When the Walker Administration proposed in February, as part of the “budget repair” bill, that DHS should be allowed to make changes to Medicaid that conflict with state statutes, advocates and many others argued that the unprecedented shift in policy-making authority should be handled in the budget bill, so there would be more time to debate it. DHS insisted that handling the cuts and/or the power shift in the budget bill wouldn’t be soon enough to achieve the savings needed. Now almost 7 months after the legislature approved the budget repair bill’s provisions, which give unelected officials in DHS sweeping power to rewrite Medicaid and BadgerCare policy, we have only seen a tiny fraction of the department’s plans for how they will achieve nearly $450 million of cuts. 
• The department’s self-imposed December 31 deadline – The measures approved in the budget repair bill (and subsequently made a little more problematic by the budget bill) include a December 31 deadline, which was proposed by the Governor, for federal action on the state’s request for waivers of federal laws that conflict with the DHS proposals. If the state doesn’t get a waiver from federal officials by that self-imposed deadline, the bill directs DHS to reduce the income eligibility cap for parents and childless adults to 133% of the poverty level. Reducing that eligibility ceiling from the current 200% level is expected to eliminate coverage of about 60,000 Wisconsinites. Since waivers often require many months of review, and the DHS proposals conflicting with the statutes have to be referred to the Finance Committee before being submitted to federal officials, the fact that it has taken DHS so long to develop its plan makes it unrealistic to expect federal approval before December 31.
• The diminishing opportunities for public input – Advocates believe very strongly that Medicaid and BadgerCare enrollees and potential program participants should have an opportunity for meaningful input – at both the state and federal level. As the process of developing and unveiling the department’s proposals drags out, the opportunity for robust public involvement is greatly diminished by the looming December 31 deadline set by the state legislation. Our hope is that there will be public hearings, as well as the new opportunity to comment online about the proposals.

For information on some of the very detrimental changes that could be proposed in the waivers, see WCCF’s short September 9 paper.  We will follow up this blog post over the coming weeks once we finally learn what DHS has in mind for achieving about $450 million of additional cuts to Medicaid and BadgerCare.