Wisconsin Medicaid Coalition forms to protect program

A report from the budget scorekeeper for Congress confirms that a House committee cannot reach its spending reduction goal without “deep cuts” to Medicaid, a state coalition formed in recent months to protect the program said Thursday.

The House passed a budget framework last week that directs the Energy and Commerce Committee, which has jurisdiction over Medicaid, to find $880 billion in savings over the next decade as part of a push to cut government spending and fund President Donald Trump’s agenda.

On Wednesday, the Congressional Budget Office found the committee oversees $581 billion in spending that is not related to Medicaid or Medicare.

Congressional leadership has promised no cuts to Medicare, which would mean a minimum of $299 billion in cuts to Medicaid, according to the Wisconsin Medicaid Coalition.

Last month, the coalition released data showing Medicaid infused $11 billion into the state’s economy. The program reimburses health and long-term care for 1.2 million Wisconsinites.

A recent letter to the state’s congressional delegation that calls for no Medicaid cuts now has the backing of 115 organizations, including providers, advocacy groups for Medicaid members and counties.

Four advocates have taken the lead in launching the coalition:

• Lisa Hassenstab, public policy manager for Disability Rights Wisconsin
• Tami Jackson, public policy analyst and legislative liaison for the Wisconsin Board for People with Developmental Disabilities
• William Parke-Sutherland, government affairs director for Kids Forward
• Janet Zander, advocacy and public policy coordinator for the Greater Wisconsin Agency on Aging Resources

They spoke to Wisconsin Health News last week. Edited excerpts from the interview are below.

WHN: What role is the coalition playing? 

Jackson: We’ve been doing some work to help people as they engage with their members of Congress and with their local elected officials, whether that’s at the county board level or their state lawmakers. One of the things that is true is that Medicaid actually engages with lots of people. There’s lots of people who are implementing Medicaid. These dollars are really going into local communities in a high volume, and lots of different hands are touching these dollars and being touched by them …

As Congress gets clearer about what they are proposing, this is a group that is interested in being engaged and bringing a face and an impact to: What does this mean to a very local area, to my business or to my workers? They’re very interested in helping other people understand the impact that this program has on the state and their neighbors.

Hassenstab: We’ve approached this using the terminology of a big-tent coalition … bringing together a diverse group of people who engage with Medicaid in a lot of different ways, but also recognizing that the depth and breadth of cuts that are being discussed at the federal level are going to have significant impact across all of these organizations and the populations that they represent. We’re providing a united front in this messaging around this to show that it’s not just kids, it’s not just people with disabilities and it’s not just older adults who care about this.

WHN: What could these cuts mean for Wisconsin? 

Jackson: There will be lots less money coming from the federal government to help the state operate its current Medicaid programs. Once the state gets less money, they can do one of four things: increase the amount of state money that they put in to keep doing things exactly as we are now; choose who can or can’t get into the Medicaid programs; choose what services are or aren’t offered; and choose how much to pay the people who are working to provide health and long-term care.

So with federal cuts, if you get a lot less money as a state, you are starting to make decisions about cutting the programs that you have now. We certainly work with many people who need a lot of help or a little help over a long period of time. They are telling us that they do not have the help they need now. Any cuts to what we’re doing now really would tip families, people with disabilities and other populations as well, like older adults, into a crisis. It is the difference between, ‘Can I stay living independently in the community or am I going to move to an institutional setting?’ Which, by the way, is also Medicaid-funded at a much higher rate. And I think that’s where we see the threats that are going on in Washington to be fundamental to what we have already built here.

Parke-Sutherland: Tami just talked about services that keep people with disabilities and older adults in their homes. Home and community-based services, like Family Care and IRIS, are optional services. So the federal government has said these are services you must provide, and these are services you can provide. Wisconsin is one of the states that provides for, I think, all optional services, or almost all optional services.

So when we’re cutting back services, one of those four bad choices that Tami articulated, we would be cutting things like home and community-based services; prescription drug coverage, which is optional; physical therapy and occupational therapy and speech therapy; dental and vision services; and case management services to help people coordinate care if they need that. Those are the kinds of things that are optional, so those are the things that would be on the chopping block. Those are services that often cost less and are preventative.

Zander: You start eliminating those optional services, which are preventative or early intervention, and you’re going to see much higher costs down the road. Each budget, it’s going to get more expensive as people don’t seek out the help that they need early on and they’re now in much more serious medical conditions or aren’t taking their prescriptions until we have a medical incident. Those kinds of things will end up costing us far more, and it really will not be the savings that they think they’re going to find.

WHN: Republicans have said they’re focusing on cutting waste, fraud and abuse. What’s your response? 

Jackson: There’s no program that moves around trillions of dollars that has zero fraud, abuse and waste. But it’s also true in this state that we have an incredible number of people who are really working to make sure that nobody who is not eligible for these services gets into the programs. We have a lot of parameters in place that are screening out reimbursements that don’t have the right documentation and mistakes.

Parke-Sutherland: The cuts that are being discussed by the House of Representatives and the Republicans dwarf the amount — any amount — of fraud, waste and abuse that might be in Medicaid.

And these cuts are being rushed through pretty quickly. So if what we’re really wanting to do is take a long time, understand what’s happening in Medicaid and implement some reforms so that Medicaid can be more efficient — these kinds of broad-based cuts that don’t really have a factual basis are not going to do anything to make Medicaid more efficient. They’re going to increase healthcare costs overall, to the extent that they’re going to lead to people without insurance seeking care in emergency rooms, where there’s a requirement for that care to be provided. We know that will have a knock-on effect on the whole system. And that is not to say anything about the direct cuts to provider payments that would happen if we cut services.

Zander: We have 1.2 million people who are annually reviewed and determined to be re-eligible or not, and referred to other services. The amount of enrollment error and things in this state is incredibly low because we have such a robust system of checks and balances. Provider claims get processed through the state before they’re passed on to the federal government. We just do a really good job here in this state. Some might say it’s a very difficult route for many of our providers and people to get enrolled. But, in fact, it is the thing that has kept us from having a lot of issues related to fraud and abuse.

WHN: What are the next steps? 

Hassenstab: We’re encouraging continued communication, particularly with members of Congress, around this issue (and continuing) to tell the stories of what the potential impacts could be. We’ll also be tracking what these proposals end up looking like in the actual budget proposal … Medicaid wasn’t mentioned in the budget resolution. There are no numbers attached to it. We’re going to start seeing those things. Being able to interpret what that might end up looking like in terms of impact for Wisconsin is going to be a big part of what the four of us will be doing and trying to convey to the broader coalition.

And then encouraging folks to talk with their state legislators … What (Medicaid) really means to communities and what it really means to people is a story that we’re asking folks to reach out to their elected officials to help them understand that this isn’t just dollars. This is people’s lives, and this is communities’ lives.

This article first appeared in the Wisconsin Health News daily email newsletter. Sign up for your free trial here.