A change in federal Medicaid policy announced in February creates an exciting opportunity to improve health care for Native Americans. It’s an opportunity that Wisconsin tribes and state officials should seize in order to help alleviate the extreme disparities in health between Native Americans and whites in Wisconsin.
The revised interpretation of Medicaid reimbursement policy expands the scope of health care services for Native Americans that are fully paid for by the federal government, without the usual requirement for state matching funds. In the past, the federal government paid 100% of the cost of Medicaid services provided directly by Indian Health Services (IHS), but not for health care provided outside of IHS facilities. Under the new policy, federal funding will also cover the full cost of Medicaid services delivered to American Indians by providers under contract with IHS, if IHS or a tribal practitioner refers the Medicaid patient and continues to oversee their care. Read more
The latest quarterly report from the Department of Health Services (DHS) projects that state spending for Medicaid and related services during the current biennium will be $85.2 million less than the state budgeted. That amounts to $12.6 million less state spending than the state estimated in its last update, three months ago. (I’m focusing just on the state share of spending; the total reduction from all sources is almost $203 million, relative to the amount budgeted for 2015-17.)
Granted, Medicaid spending trends can change rapidly, but the DHS report is welcome news – particularly since other budget indicators aren’t so good. Recently reduced estimates of national economic growth in 2016 suggest the possibility of less state revenue growth than anticipated, and as we noted in a recent blog post, state tax collections dropped by $91 million in February. Against that backdrop, the latest DHS report provides a bit of positive news relating to the prospects for keeping the state budget in the black. Read more
Sizing up the ACA’s Accomplishments on its Sixth Birthday
The federal health care reform law turned six today, and for a relatively young law it has made remarkable progress in reducing the number of uninsured Americans and improving access to quality, affordable health care. A WCCF blog post outlines some of the data illustrating the Affordable Care Act’s accomplishments, and for the law’s sixth birthday I’ve distilled those into the six achievements described below.
Of course, the law has its detractors – including many Republican officeholders and candidates who seek to repeal it. During the election campaigns in the months ahead, I hope there will be robust debate about the laws effects – grounded in solid data. I hope the proponents of repealing the ACA will explain how they would replace it and how they would improve upon, or at least avoid reversing, the following accomplishments: Read more
Wisconsin Lags Far Behind in Reporting on National Standards
This week has been Sunshine Week, which is the annual nationwide celebration of access to public information. That makes this a good time to bring up an area where Wisconsin needs to let in considerably more sunshine – health care quality measures for children served by Medicaid and the Children’s Health Insurance Program (CHIP). Federal law encourages voluntary reporting of those measures, but Wisconsin is lagging well behind most other states in reporting that information. Read more
“Benefit cliffs” in public assistance programs have suddenly become a pressing topic for legislators who contend that safety net programs penalize work and deter people from taking higher paying jobs. A new report analyzes those arguments and shows that the structure of public benefits is not the deterrent to work that some people seem to believe. It explains why eliminating benefit cliffs could hurt substantially more people than it would help.
In the Wisconsin legislature, Republican leaders have put a resolution relating to cliff effects on a fast track. Their open-ended proposal, AJR 109, would direct two state agencies (DHS and DCF) to develop plans for reducing or eliminating benefit cliffs. It was approved by a voice vote in the Assembly within a week of being introduced, without ever getting a public hearing, and it now awaits a vote in the Senate (also without a hearing).
[Update: The state Senate finished up its session on March 15 and did not take up AJR 109, so the proposal is dead for this year. Read more
Federal officials recently released the 2016 Federal Poverty Income Guidelines, better known as the federal poverty levels (FPL). States and the federal government use the guidelines to determine eligibility for many public assistance programs, such as Medicaid, BadgerCare and child care subsidies.
Our website has several tables showing the new poverty levels and how they relate to eligibility for various public benefits. In addition to showing the annual income figures, the tables convert those into monthly and hourly income. Read more
Proposal to Alleviate “Cliff Effects” Could Significantly Reduce Assistance for Many
Two legislative leaders have proposed a resolution that could result in very significant changes in public benefits, but we don’t know what those changes will be. The resolution that was introduced yesterday – as Senate Joint Resolution 102 and Assembly Joint Resolution 109 – may be scheduled for a floor vote next week without ever getting a public hearing, and after almost no opportunity for public input!
The stated objective of the resolution sounds good – alleviating the “cliff effects” in public benefit programs. In other words, the goal is to redesign public benefit programs so people don’t hit or fall off a “cliff” when their family income reaches the eligibility ceiling. Legislators in both parties and advocates for public assistance programs agree that that’s a very worthwhile objective. But there are good and bad ways to eliminate or reduce cliff effects (none of which are easy), and the vague resolution doesn’t indicate what solution(s) the authors have in mind. Read more
President Obama’s Budget Would Make Expansion an Even Better Deal
The budget bill introduced this week by President Obama would make the expansion of Medicaid an even better deal for states like Wisconsin that have not yet taken up the option. If Wisconsin expanded BadgerCare eligibility in January 2017, the president’s recommendations would increase the savings for Wisconsin taxpayers by $252 million by the end of fiscal year 2021.
The president’s proposal calls for reimbursing each state for the full cost of newly-eligible adults for the first three years after expanding coverage, regardless of when the expansion begins. As a result, states that expand coverage of adults this year or any time in the future would get the same enhanced federal funding as the states that expanded coverage in 2014. Read more
[January 4th UPDATE: The quarterly Medicaid report issued today by the Dept. of Health Services estimates that the changes I discuss below and a couple of smaller items are expected to yield net savings of $72.6 million GPR by the end of the biennium.]
A couple of factors should yield significant savings in state spending for Medicaid and BadgerCare during the current biennial budget. If state tax collections don’t fall short (which is a definite possibility), Medicaid savings could be used to build up the states meager budget reserves, and I hope state policymakers will also invest a little in initiatives to make the health care system more efficient, in order to hold down the future growth of Medicaid spending.
Early next week the Department of Health Services (DHS) should release a quarterly report about Medicaid spending from October through December. I expect that report to shed a little more light on the potential savings, but DHS might focus just on the estimated savings during that specific quarter, and not on the much larger savings over the next 18 months of the biennium. Read more
Two state senators released a Legislative Fiscal Bureau (LFB) memo today that provides an updated estimate of the potential savings to Wisconsin from expanding BadgerCare to more adults. The Fiscal Bureau estimates that expanding BadgerCare for adults up to 133% of the federal poverty level would cover an additional 83,000 adults, but would yield a net savings for the state of more than $1 billion over a six-year period – by taking advantage of increased federal funding available for states that expand Medicaid.
If the expansion were to begin on January 1, 2016, the net savings for state taxpayers during the 2015-17 biennial budget period would be $323.5 million. Because that starting date is no longer a realistic option, the paper also lays out the projected fiscal effect of beginning expanded coverage a year later. Under either of those two options, Wisconsin would save an average of more than $15 million per month once the change took effect. Read more